Thyroid Problems in Children


The thyroid is a butterfly-shaped gland located in the neck, and although it is small, it produces hormones that impact critical body functions, such as energy level and heart rate. When the thyroid stops working properly in kids, it can affect everything from growth and weight gain to school performance.

Weight & the Thyroid

Because excess weight can make the thyroid function improperly, kids who are very heavy may experience a borderline underfunctioning of the thyroid. “We tend to watch those kids rather than treat right away for hypothyroidism,” says Dr. Garber. In this situation, losing weight can normalize the thyroid. However, in general doctors do not recommend losing weight as a treatment for thyroid disorders.

Thyroid disorders in children are caused by autoimmune disease and are relatively common, says Evan Garber, DO, attending pediatric endocrinologist at Nemours/AI duPont Hospital in Wilmington, DE, especially in kids who already have an autoimmune condition, like Type 1 diabetes. Thyroid disorders affect more girls than boys, typically during adolescence. Family history may slightly increase the risk of thyroid problems, but doctors don’t recommend screening for thyroid disorders unless they suspect a problem.

There are three types of thyroid disorders: hypothyroidism, also called Hashimoto’s disease; hyperthyroidism, also known as Grave’s disease; and congenital hypothyroidism. The first two disorders present later in life; the last, almost immediately.

Congenital hypothyroidism

Margherita Smith’s daughter Scarlett was a bit jaundiced at birth and perhaps a little sleepy, but nothing raised a red flag for the new mother from Philadelphia. When Scarlett was 9 days old, however, newborn-screening test results revealed that she had congenital hypothyroidism.

About 1 in 2,000 babies is born in the US each year with this particular thyroid disorder. Symptoms such as jaundice, an enlarged tongue and an umbilical hernia present in extreme cases, but most babies don’t show any signs of thyroid troubles. Because delayed treatment could result in significant intellectual disabilities and growth abnormalities, babies nationwide are screened at birth for this condition.

The treatment for babies with congenital hypothyroidism is a once-daily medication in pill form that can be mixed with breast milk or formula and placed directly in the mouth. And while Scarlett will take the medication for the rest of her life, at 3½, she’s sharp, active and growing properly, her mother reports: “You would never know. She never shows any signs or side effects.”

Next page: symptoms of and treatment for hypothyroidism and hyperthyroidism


Hypothyroidism / Hashimoto’s disease

Hypothyroidism is characterized by an underactive thyroid, a condition in which the thyroid gland does not make enough thyroid hormone. “The most common sign is poor growth in younger children,” says Dr. Garber.

The Thyroid & School Performance

There is usually no change in school performance for kids with hypothyroidism, but academics can be “profoundly affected” by hyperthyroidism, says Dr. Bauer. Hyperthyroidism affects cognitive functioning, so patients are often distracted and have trouble completing tests on time. To help, doctors are often willing to write notes to school to ask that hyperthyroidism patients get more time on tests or the ability to take makeup tests. “Most school systems have been pretty understanding,” says Dr. Bauer.

Other symptoms include:

  • Fatigue
  • Weight gain
  • Constipation
  • Cold intolerance
  • Slow pulse
  • Dry skin; dry hair; brittle nails

“This is probably the easiest type to treat,” says Dr. Garber of hypothyroidism, because the medication that replaces the thyroid hormone is very well tolerated. It also helps kids who have been growing slowly catch up to their correct height.

Hyperthyroidism / Grave’s disease 

Grave’s disease, which is characterized by an overactive thyroid, is much less common than Hashimoto’s. “On a day-to-day basis it’s a much more debilitating disease,” says Andrew J. Bauer, MD, medical director of the Pediatric Thyroid Center at Children’s Hospital of Philadelphia.

Symptoms include:

  • Anxiousness; irritability; nervousness
  • Increased appetite with or without weight loss
  • Always feeling warm
  • Hyperactivity; restlessness; fidgeting
  • Difficulty concentrating; poor performance in school

Treatment for hyperthyroidism can be a bit more complicated, says Dr. Garber. Typically, there are three options. First is an oral medication that blocks the thyroid’s production of hormones. According to Dr. Bauer, 50 percent of hyperthyroidism patients on this regimen achieve remission after five to seven years. Within that group, 35 to 40 percent have a recurrence, so the overall remission rate is about 35 percent, he says.

There are two additional permanent treatment options for patients who do not achieve successful treatment of their hyperthyroidism with medication: radioactive iodine ablation, which medically destroys the thyroid gland; and surgical removal of the thyroid gland. Finding an experienced facility for treatment is important, especially when considering surgery, says Dr. Bauer. “The younger the patient, the higher the risk of surgery,” he says. He recommends finding a surgeon who does at least 15 to 30 pediatric thyroid surgeries a year.

While having an out-of-balance thyroid can be unsettling, the good news is that thyroid conditions are manageable. With treatment, kids can return to feeling like kids again.

Suzanne Koup-Larsen is a contributing writer to MetroKids.


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