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Managing Thyroid Disorders in Children and Adolescents

Managing Thyroid Disorders in Children and Adolescents

Managing Thyroid Disorders in Children and Adolescents
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Thyroid disorders may not be as common in children as scraped knees, but they certainly are more concerning. While scraped knees may heal quickly, thyroid disorders, though less common, can affect a child’s energy level, mood, and even their physical and cognitive development. This is why staying informed on potential thyroid issues and their symptoms is crucial for parents when navigating their child’s well-being.

The thyroid gland, a butterfly-shaped organ located in the neck, produces hormones essential for growth and development. Genetic predisposition, autoimmune disorders, and iodine deficiency are among the major factors contributing to thyroid disorders in young individuals. Early detection is especially important to effectively manage these disorders.

In this article, we will explore the signs of thyroid problems in children, the different types of thyroid disorders, the signs and symptoms of these conditions, diagnostic methods, treatment options, and tips for long-term management.

Common Thyroid Conditions in Children and Adolescents

1. Hypothyroidism

This occurs when the thyroid gland doesn’t produce enough thyroid hormones. It can be present at birth (congenital hypothyroidism) or develop later in life (acquired hypothyroidism). Congenital hypothyroidism can lead to cognitive and developmental problems if not promptly treated. Acquired hypothyroidism is frequently caused by Hashimoto’s thyroiditis, an autoimmune disorder that causes an inflammation of the thyroid.

Symptoms in children can be subtle and vary depending on age. In infants, common signs include constipation, feeding difficulties, prolonged jaundice, and delayed development of motor skills. In older children and adolescents, symptoms may include fatigue, poor growth, weight gain, cold intolerance, dry skin, and irregularities in menstruation.

2. Hyperthyroidism

This is caused by excessive thyroid hormone production. Although more common in adults,  hyperthyroidism in children can impact growth and puberty. Hyperthyroidism is also less common than hypothyroidism in the general population, including children and adolescents.

Like hypothyroidism, hyperthyroidism can also be present at birth or acquired later in life. Congenital hyperthyroidism, however, is very rare. The most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder that affects the thyroid. 

Symptoms include weight loss, rapid heartbeat, anxiety, fatigue, sweating, difficulty sleeping, and frequent bowel movements. Growth may be accelerated in younger children, while adolescents may experience stunted growth due to premature closure of growth plates.

3. Thyroid Cancer

Thyroid cancer occurs when cells of the thyroid gland begin to multiply rapidly and uncontrollably. Compared to hypothyroidism and hyperthyroidism, thyroid cancer is less prevalent. While thyroid cancer is relatively uncommon in children compared to adults, it can still occur, and its incidence has been gradually increasing. Pediatric thyroid cancer is, in fact, the most common type of endocrine cancer in children, although it accounts for a small percentage (approximately 3%) of all childhood cancers.

There are four main types of thyroid cancer, with papillary thyroid carcinoma being the most common type in children. Symptoms can be subtle and may include a lump in the neck, difficulty swallowing, or changes in voice. Exposure to radiation, family history of thyroid cancer, and certain genetic conditions may increase the risk of thyroid cancer in children.

Diagnosis and Treatment

Recognizing symptoms such as fatigue, weight changes, changes in academic performance, and mood swings can aid in early detection of some thyroid disorders. However, diagnosing thyroid problems solely based on signs and symptoms can be challenging because these symptoms are not specific to thyroid disorders and often mimic other conditions. 

If you suspect a thyroid issue in your child, take them to see their pediatrician or endocrinologist for an assessment of their symptoms and a physical evaluation. For an accurate diagnosis of thyroid conditions, doctors rely on medical procedures such as blood tests (thyroid function tests), biopsies, and diagnostic imaging techniques. The kind of diagnostic test performed depends on the suspected condition.

1. Treatment for Hypothyroidism

The mainstay of treatment for hypothyroidism is levothyroxine, a synthetic T4 hormone that replaces the missing hormone. The dosage is individualized based on factors such as the child’s age, weight, and blood test results. 

Guidelines on taking levothyroxine are available to ensure an optimal therapeutic outcome. The medication is typically taken once daily, ideally around the same time every day, and on an empty stomach for optimal absorption. Ensure that your child’s doctor knows about all medications and supplements your child is already on, as some can interact with levothyroxine.

2. Treatment for Hyperthyroidism

Treatment options for hyperthyroidism aim to reduce thyroid hormone production. These include:

  • Antithyroid medications: Methimazole is the primary medication used in children and adolescents. It works by blocking the thyroid gland’s ability to use iodine to produce hormones.
  • Radioactive iodine (RAI) therapy: This treatment involves taking a small amount of radioactive iodine, which is absorbed by the thyroid gland and destroys some of the thyroid tissue, reducing hormone production. This is usually a permanent solution but may result in hypothyroidism, in which case, your child may require lifelong levothyroxine therapy.
  • Thyroid surgery: This procedure involves removing part or all of the thyroid gland. It is usually considered a last resort due to potential complications like scarring and damage to surrounding structures. However, it may be an option if medication is not tolerated or effective.

3. Treatment for Thyroid Cancer

Early detection and treatment of thyroid cancer in children and adolescents are crucial for achieving the best possible outcome. Most cases of childhood thyroid cancer are highly treatable with excellent long-term outcomes. Treatment for childhood thyroid cancer usually involves surgery (thyroidectomy) to remove a part of or the entire thyroid gland, usually followed by radioactive iodine ablation to destroy any remaining thyroid tissue. 

Long-Term Considerations and Management Tips for Parents

Most children with thyroid problems can lead healthy lives with proper diagnosis and treatment. However, long-term monitoring is very important. 

Children with hypothyroidism may require medication adjustment as they grow and their metabolic rate changes. For children and adolescents with Graves’ disease, the most common cause of hyperthyroidism, there’s a chance of recurrence after discontinuing treatment with antithyroid drugs. For children and adolescents who have undergone treatment for thyroid cancer, follow-up is essential to monitor for recurrence and management of any potential side effects of treatment, such as post-thyroidectomy hypothyroidism. If hypothyroidism develops after thyroid surgery, it is managed with thyroid replacement therapy.

Here are some tips for parents and guardians to help their children manage thyroid conditions:

1. Medication Adherence

Taking medication as prescribed is crucial for managing both hypothyroidism and hyperthyroidism. Parents and caregivers can play a vital role in ensuring children take their medication consistently. It is also important to note that if your child is on levothyroxine and they forget to take a daily dose, they should not take a double dose the next day. It’s instead best to resume the regular schedule on the next day.

2. Monitoring and Follow-up

Working closely with a pediatric endocrinologist ensures specialized care tailored to the unique needs of children and adolescents with thyroid disorders.  The frequency of follow-up appointments may vary depending on the specific condition and its severity. Regular check-ups are essential to monitor thyroid function, adjust medications, and address any emerging concerns. For instance, children with hypothyroidism require close monitoring of their growth and development.

3. Mental and Emotional Health Support

Thyroid disorders, especially untreated hypothyroidism, in children and adolescents can affect their academic performance, emotional well-being, and overall quality of life. Children and adolescents with thyroid disorders may experience fatigue, difficulty concentrating, or mood swings, and they can benefit from professional mental health support. A holistic approach involving healthcare providers, educators, and family support can be especially helpful in addressing these challenges. As a parent or guardian, having an open conversation about the condition with your child and addressing any concerns they may have is one way to provide them with the emotional support they need. Connecting with other families dealing with similar challenges may also provide valuable support.

4. Dietary Considerations

While no specific diet cures thyroid conditions, a healthy, balanced diet can support overall health. In some cases, individuals with hyperthyroidism may need to limit foods high in iodine. Also, if your child has Hashimoto’s thyroiditis, following an anti-inflammatory diet may help manage their symptoms.

Consulting a registered dietitian (RD) can be beneficial. An RD can provide personalized dietary advice for managing your child’s thyroid condition. They can help you create a balanced meal plan that meets your child’s nutritional needs and considers any dietary restrictions they may have.

Key takeaways

  • In children, thyroid function is pivotal for physical and mental maturation.
  • Recognizing the symptoms and seeking medical evaluation are vital steps in ensuring proper diagnosis and management. 
  • With consistent treatment and parental support, children with thyroid conditions can thrive and reach their full potential.
  • Early diagnosis, proper treatment, and consistent monitoring can ensure optimal health and well-being throughout childhood and adolescence.
  • Managing thyroid health in children and adolescents requires a collaborative effort between healthcare providers, parents, and the child themselves (as age-appropriate). 
  • Regular check-ups, adherence to prescribed treatments, and lifestyle modifications contribute to the successful management of thyroid disorders in children and adolescents.

Disclaimer

At ThyForLife, we do our utmost to provide accurate information. For detailed medical information regarding diagnosis, treatment, and general practices please consult your healthcare professional. Always listen to the advice of your healthcare provider.
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