Signs and Symptoms of Hypothyroidism in Children

Low thyroid function can affect growth and development

tired boy sleeping on books
Fatigue and excessive sleeping may be a sign of low thyroid function (hypothyroidism). Daniel Grill/Getty Images

Thyroid problems can affect children as much as adults, but they are not as common as some parents might believe. While some parents will casually attribute a child's weight gain to a "thyroid issue," it's not usually the case.

When thyroid problems do occur in children, it is more often related to an underactive thyroid gland, also known as hypothyroidism. This results in the reduced production of thyroid hormones which, in turn, can lead to metabolic problems in children, including short stature, delayed puberty, and fatigue.

The cause of hypothyroidism can either be congenital (meaning inherited from your parents) or acquired (caused by other conditions such as Hashimoto's disease, iodine deficiency, or radiation treatment). It is estimated that one in every 1,500 to 3,000 children will get congenital hypothyroidism, while one in 100 will develop acquired hypothyroidism.

Low thyroid function is problematic as it can interfere with a child's normal growth and development. The fatigue it causes can interfere with performance at school and rob children of the energy needed for sports and other activities.

Congenital Hypothyroidism

The most common cause of congenital hypothyroidism is thyroid dysgenesis wherein the thyroid gland is either missing, deformed, or severely underdeveloped. Thyroid dysgenesis accounts for around 85 percent of all congenital hypothyroid cases.

Other causes include a condition called thyroid dyshormonogenesis, in which thyroid hormones are not being properly synthesized due to a genetic defect.

Most newborns with congenital hypothyroidism will have no signs of the disease. Those that do may exhibit lethargy, poor feeding, constipation, and a hoarse cry. Another tell-tale sign is prolonged jaundice. This is when the yellowish color of a newborn's skin, seen in around 50 percent of full-term babies, persists for longer than two weeks.

Primary thyrotropin or thyroxine (T4) testing is the mainstay of diagnosis in newborns. Once a positive diagnosis is made, the aim of treatment is to normalize hormone levels so that the child can develop normally, both physiologically (relating the body) and neurologically (referring to the brain and nervous system).

Acquired Hypothyroidism

Hashimoto's disease (also known as Hashimoto's thyroiditis) is, by far, the most common cause of acquired hypothyroidism. It is an autoimmune disorder in which the immune system malfunctions and launches an attack on healthy thyroid tissue.

Acquired hypothyroidism is seen at four times the rate in girls than in boys. One of the characteristic signs is the swelling of the neck caused by the enlargement of the thyroid gland (goiter). Other symptoms of hypothyroidism include:

  • Short stature or a deceleration of growth
  • Rough, dry skin
  • Constipation
  • Cold intolerance
  • Headaches
  • Fatigue
  • Excessive sleeping
  • Vision problems
  • Easy bruising
  • Milky nipple discharge (galactorrhea)
  • Menstrual irregularities
  • Delayed puberty (often the first obvious sign in the teen years)
  • Early puberty (mostly seen in children with severe, longstanding disease)

A physical exam and T4 testing can be used to make a diagnosis.

The treatment approach is essentially the same as for congenital hypothyroidism. The goals of therapy are to maintain normal hormone levels and to ensure normal growth and development through childhood and adolescence. The dose is customized for the child and rechecked every three to six months until he or she reaches full height.

Childhood Obesity and Thyroid Problems

Overweight and obese children in the U.S. is growing problem but one that is rarely caused by hypothyroidism. In fact, it has become something of a cliché to label these problems as "glandular" when most are caused by a poor diet and lack of exercise.

Children with hypothyroidism may sometimes look as if they’re carrying extra pounds because they’re not getting taller. But in most cases, it is being overweight that can lead to changes in thyroid function rather than the other way around. Particularly in children, a raised TSH level is more often the consequence of obesity and not the cause.

Source:

Hanley, P.; Lord, K.; and Bauer, A. "Thyroid Disorders in Children and Adolescents A Review." JAMA Pediatrics. 2016; 170(10):1008-1019. DOI: 10.1001/jamapediatrics.2016.0486.

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