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The Thyroid gland and Children

The Thyroid gland is a very important Endocrine gland (a gland that produces hormones) situated in the front of the neck. 

The hormones it produces plays a very important role in many aspects of life. In fact, is essential for pretty much all functions of our body from growth to puberty to development of the brain, bone strength and metabolism

An abnormal production of the hormones from the thyroid gland can present with skin and hair issues, early puberty, gaining or losing weight, effect on the gut, effect on the brain and eyes, effect on the immune system to mention a few.

The thyroid gland produces two hormones: T3 (triiodothyronine) and T4 (thyroxine)which is controlled by the pituitary gland in the brain which produces the Thyroid stimulating hormone. They work in tandem together to maintain the delicate balance providing the body with just the right amount of the hormones: not too much or too little. 

Sometimes however there may be a problem in this delicate balance which may lead to overproduction of the thyroid hormones (HYPER-thyroidism) or under production of the thyroid hormone (HYPO-thyroidism).

Congenital Hypothyroidism: Babies, in the first few days after birth are checked for a specific type of thyroid disorder: congenital hypothyroidism. This test is done through a small prick on the heel of the child just before they are discharged from the hospital. The thyroid hormone plays a very important role in the early growth and brain development of babies. The detection of the underproduction of thyroid hormones early leads to early intervention and institution of treatment preventing poor neurodevelopment of the baby. 

Although this screening test fortunately with more and more babies having the screening test at birth the detection of congenital hypothyroidism is early leading to excellent outcomes in the affected babies. 

It is important to remember that even if the initial new-born test is normal a child may develop thyroid disorder at a later stage. 

HYPO-thyroidism: 

This happens when the production of the thyroid hormone does not meet the requirement of the child's body. 

The common presenting symptoms are:( The list is not exhaustive)

1. Fatigue/tiredness/excessive sleepiness

2. Weight gain despite normal or poor appetite

3. Change in hair and skin: becomes coarse and dry

4. Thinning of the ends of the eye brows

5. Hair fall

6. Puffy face

7. Constipation

8. Feeling more cold than usual 

9.Recurrent muscle cramps

10. Goitre: a swelling in the front of the neck 

11. Menstrual irregularities: excessive bleeding

There are many reasons why a child may develop hypothyroidism: 

Autoimmune: This happens when the cells of the immune system attack the thyroid gland and destroy. 

Central: the signalling of TSH from the brain is affected which causes the gland to malfunction. As the brain controls all the hormones from various glands, this type could present with other hormonal issues as well. 

If your child is suspected to have hypothyroidism, your Paediatric Endocrinologist will examine your child thoroughly and ask for a panel of blood tests which will include a thyroid function test. They may also check for the antibodies that the immune system produces that may destroy the gland and an ultrasound scan on the thyroid. 

Once the diagnosis is confirmed, the treatment consists of a replacement dose of the thyroid hormone which is a tablet. The dose of this will be adjusted by regular follow ups and blood tests especially in the initial formative and growth years. 

If appropriately managed the child will lead an absolutely normal life. Compliance is the key here. 

HYPER-thyroidism (overactive thyroid):

This happens when the thyroid gland produces too much hormones. This causes the body's metabolic system to go into overdrive. 

Children hence present with:

1.Anxiety, being restless

2. Poor sleep/ disturbed sleep

3. Weight loss

4. Diarrhoea or recurrent need to open bowels

5, Feeling warm all the time

6. Heart racing

7. Swelling in the front of the neck.

8. Mood changes

9. Decreased ability to concentrate. 

The thyroid gland may become overactive because of many reasons: 

Autoimmune also known as Grave's disease which may affect the eyes too.

A nodule on the thyroid gland that produces excessive thyroid hormone which spills over into the blood

Sometimes the thyroid gland may become inflamed occasionally after an infection causing a temporary increase in the production of the thyroid hormone which generally settles on its own.

The management of an overactive gland is very different to that of an underactive gland. Your Paediatric endocrinologist after an evaluation on the hormone levels and scan of the gland may advise a radioactive scan to assess the gland especially if a nodule is detected. In case of a nodule a fine needle aspiration the test the nodule may also be recommended. 

Once the diagnosis is established, medicines will be commenced to control the effect of the high thyroid hormone levels in the blood. The dosage of the medication will be based and changed based on the blood levels of the hormone and the resolution of symptoms. If the symptoms persist or worsen despite the medication or the child experiences side effects of the medication or when a more permanent solution is needed, then your doctor will recommend either surgery of the thyroid gland or ablation on the gland using Radioactive iodine. The choice of these will be discussed with the parent depending on the child's age and symptoms

In summary hypothyroidism is more common than hyperthyroidism. In either of them early diagnosis and management leads to good outcomes.


                                                 
By Dr. Suruchi GoyalAgarwal, Consultant - Paediatrics and Paediatric Endocrinology, Columbia Asia Hospital Whitefield


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