“More children and teens than ever seem to have hypothyroidism, a thyroid gland which does not produce enough thyroid hormone”, says pediatric endocrinologist Andrew J. Bauer, MD, medical director of Medical Center at Children’s Hospital of Philadelphia. An underactive thyroid can even put on grip on and interfere with normal growth and development. Additionally, the fatigue hypothyroidism in children and infants causes can ultimately hinder performance at school and leave kids without enough energy for sports and play.
What should we known about hypothyroidism in children?
“We used to think that one or two in 100 kids and adolescents would develop hypothyroidism, but today it looks like two to three in 100 do,” states Dr. Bauer, co-author of a current review of childhood thyroid ailments for pediatricians and family physicians published in JAMA Pediatrics. “We don’t know the entire extent of hypothyroidism in young men and women in the United States, but numbers seem to be increasing along with levels of other autoimmune conditions. We do not know why. It may be that more children as well as teens are being analyzed, so we’re finding it.
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The “hygiene hypothesis”, that residing in clean surroundings early in life can throw away the immune system, is just another potential explanation.” Here’s what parents should know about this thyroid condition:
Hypothyroidism is Common in Children
Routine testing at birth uncovers hypothyroidism in one of every 1,500-3,000 newborns. The cause is a problem with the growth of the thyroid gland, the gland found at the base of the neck. “Early identification and treatment of thyroid hormone deficiency is crucial to ensure normal physical growth and normal brain growth,” Dr. Bauer says. “Screening for thyroid disease should be a part of all newborn screening programs in America.”
But, hypothyroidism may also develop later in childhood or the teen years. The risk is four times higher in girls than in boys. And people with a family history of autoimmune disorders or who have Turner syndrome, Down syndrome, type 1 diabetes or autoimmune disease may also be at risk of developing hypothyroidism.
The most typical cause of this “obtained” hypothyroidism is: An immune system assault on cells in the thyroid gland. Additional factors that could damage the thyroid gland or its capacity to produce thyroid hormones include radiation for cancers of the head and throat, some drugs (including lithiumion, some epilepsy medications and chemotherapy drugs called tyrosine kinase inhibitors) and, infrequently, iodine deficiency. Thanks to “iodized” salt (fortified with iodine) as well as the pure iodine in milk products, eggs and fish, this nourishment problem is comparatively rare in the U.S.
Symptoms Can Hide in Plain Sight
Tiredness, constipation, feeling cold and dry hair and skin are red signs but doctors and parents may not suspect that a sluggish thyroid as these indicators are common complaints of life, not specific to thyroid disorder. A slow-down in development, a delay in growing at puberty and, for women, irregular periods, are symptoms that are key.
“Delays in diagnosing thyroid problems are also common in children and adolescents with hyperthyroidism (a thyroid gland that produces too much thyroid gland) because of the cross-over in behaviour that is similar to anxiety and/or attention deficit disorders,” Dr. Bauer says. “We are also seeing the flip side –more parents legitimately concerned about their child’s fatigue or weight want to know if it’s a thyroid issue. If parents are concerned–especially if their child is not growing well, isn’t going through puberty when they ought to be, or if they develop unexplained and consistent indications or signs consistent with hypo- or hyperthyroidism — it is well worth mentioning to the doctor.”
Weight Gain and Obesity in Children
“Weight gain and obesity are seldom caused by hypothyroidism in children and adolescents,” Dr. Bauer says. “Parents wonder if a thyroid issue is the cause, particularly when they’re doing all they can to help a kid eat a healthy diet and be active. Children with hypothyroidism may sometimes look as if they’re carrying a few extra pounds because they’re not getting taller. But the majority of the time, it’s being overweight that can lead to changes in thyroid hormone levels.”
Extra body fat may increase levels of the hormone leptin, which then increases levels of thyroid stimulating hormone when the thyroid is currently working normally. That could look like subclinical hypothyroidism. “With weight loss, thyroid stimulating hormone levels return to normal,” Dr. Bauer says
Parents Can Check from Home
An enlarged thyroid gland is an important clue to hypothyroidism and hyperthyroidism. “Along with other ailments, it can help your doctor determine whether it is worthwhile performing thyroid testing,” Dr. Bauer explains. “But you can have hypothyroidism with no enlarged thyroid gland.” Parents can do the basic test ” he says. “We don’t encourage parents to attempt to become physicians, but with your child appear at the ceiling while you look at their neck is a fairly easy. If you are able to see the overview of the thyroid gland in this place, then the thyroid is enlarged.”
The thyroid gland is situated at the base of the neck. It extends about an inch. Check by simply looking at this area of the neck in three places to determine if there is an enlarged thyroid:
- While your child looks straight using their chin parallel to the floor.
- While your son or daughter looks up with her head and her chin pointing upward so that her neck is extended.
- As she looks up while she swallows.
About Thyroid Disease Treatment
Doctors diagnose hypothyroidism by assessing for symptoms, taking a family history, analyzing a child’s thyroid gland and analyzing levels of thyroid-stimulating hormone (TSH) and free T4 (free thyroxine). High TSH and T4 can mean hypothyroidism. Amounts of anti-thyroid antibodies, which may be elevated, may also get checked. “If a child or adolescent has hypothyroidism, the typical treatment is levothyroxine–artificial thyroid hormone to replace hormones the thyroid isn’t producing in large-enough amounts,” Dr. Bauer says.
The dose is customized for each child, so that thyroid hormone levels remain within a healthy range. Your child’s physician will recheck his or her thyroid every three to six months before she or he reaches full height–after a change in dose with more checks. “This should look after delays in growth and puberty, stop learning delays, improve energy levels and receive a young man’s life back to normal,” Dr. Bauer says.
But from time to time, that the “brain fog” or exhaustion of hypothyroidism does not fully lift with levothyroxine, ” he notes. “If that is true for your child, it is worth asking the physician whether adding a second thyroid gland, known as T3, could be advantageous,” Dr. Bauer says. “We are beginning to see advantages for many adults and kids utilizing combined T3 and T4 therapy, although, this approach remains controversial and additional research into this approach is required.” This is probably the primary reason why some patients feel better on ‘natural’ thyroid hormone — it is not that it’s a ‘natural’ product when compared with a ‘synthetic’ product but that the ‘natural’ variant of thyroid gland has both T3 and T4 from the formulation.
Meanwhile, some parents detect a sudden “side effect” of therapy: Kids who were silent and relatively inactive today have lots of energy, and may be more interested in playing and just running over sitting down to do homework. “There are usually kids with severe hypothyroidism who get all their assignments done and do not get distracted as they were too tired to do much else but sit around,” Dr. Bauer says. “Following treatment, all of a sudden you have got a typical eight-year-old who is full of energy. It may be an alteration for the patient and the parents.”
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By Dr. Alex Jimenez
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