THYROID DISEASE IN CHILDREN

Although thyroid disease occurs less frequently in children than in adults, the signs and symptoms can be similar. However, there are a few important differences that need to be brought to light.

The thyroid gland is located at the front of the neck, just below the Adam's apple. It is responsible for the rate of all metabolic and chemical processes in our body, and affects every cell, tissue, and organ. The thyroid gland is therefore essential for life, growth and development. Thyroid gland disorders consequently have a profound effect upon the human body.

When the thyroid gland produces too much thyroid hormone (overactive), the condition is called hyperthyroidism. When the thyroid gland produces too little thyroid hormone (underactive), the condition is called hypothyroidism.

Children with thyroid conditions are generally managed by a paediatric endocrinologist or a paediatrician in consultation with a paediatric endocrinologist.

Congenital Hypothyroidism

Congenital hypothyroidism is a disorder that affects infants at birth, and occurs in about 1 in 4,000 live-born babies. It is characterized by the loss of thyroid function, due to the thyroid gland failing to develop normally. In some cases, the gland is totally absent. About 10% of cases are caused by an enzyme defect leading to deficient hormone production, iodine deficiency and a brain pituitary gland abnormality. If the diagnosis is delayed, and immediate treatment is not given, congenital hypothyroidism can lead to growth and developmental defects, and severe mental retardation (cretinism).

Fortunately, routine testing for thyroid function in newborns has been mandatory since 1976. Within the first week of life, a heelprick blood sample is taken to assess an infant's thyroid hormone level. If any abnormality is found, a repeat blood sample is taken. If this confirms congenital hypothyroidism, the infant is immediately given thyroid hormone replacement therapy (T₄ - thyroxine). Normal growth and development should then continue, with no adverse effects on the child's mental capacity.

Before newborn thyroid screening began, this condition was easily missed. Even within a few days, subtle symptoms would emerge, such as poor feeding, constipation, low body temperature, cool skin, slow pulse, prolonged jaundice, increased sleepiness, and decreased crying. After a few weeks, other physical signs would become more noticeable, such as poor growth and development, dry skin and hair, poor muscle tone, slow tendon reflexes, hoarse crying, enlarged tongue, umbilical hernia, and puffiness or swelling. By this time, there would already have been some devastating consequences. Treatment with thyroid hormone replacement would have resolved most of the physical symptoms, but the child would more than likely have had permanent brain damage.

Hyperthyroidism in Newborns

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Hashimoto's Thyroiditis

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Treatment

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Side effects

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Graves' Disease

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Treatment

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Side effects

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Parent Involvement

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Robyn Koumourou is a director of Thyroid Australia.
She is writing a book about thyroid disorders and related illnesses in Australia.

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