Hypothyroidism In Children: Types, Causes, And Treatment

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Hypothyroidism in children, just as in adults, is a condition in which the thyroid gland produces insufficient thyroid hormone. The thyroid gland is a butterfly-shaped endocrine gland located below the larynx (voice box) in the front of the neck. It produces thyroid hormones, including thyroxine (T4) and triiodothyronine (T3), which are secreted into the bloodstream. The thyroid-stimulating hormone (TSH) which is produced in the brain causes the release of the thyroid hormones.

These hormones regulate your child’s metabolism and energy utilization and ensure the brain, heart, kidney, and other organs function properly (1). Therefore, thyroid dysfunction or disorders can have profound detrimental effects (2) (3).

This post discusses the types, causes, symptoms, diagnosis, and treatment of hypothyroidism in children.

Hypothyroidism In Children

The main thyroid disorders are hyperthyroidism or excessive thyroid hormone production (overactive thyroid gland) and hypothyroidism or insufficient hormone production (underactive gland). Adults are more likely to have hypothyroidism, but it is the most common thyroid condition in children and teenagers (4).

The clinical presentation of hypothyroidism may vary among different children, and they may have different symptoms than adults. Many of these clinical manifestations are non-specific and may be overlooked as routine aspects of daily life (5) (6).

Symptoms Of Hypothyroidism In Children

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Hypothyroidism may go unnoticed since its symptoms develop slowly and resemble those of other diseases or medical conditions (5) (6).

However, according to the American Diabetes Association and the Pediatric Endocrine Society, children may exhibit the following hypothyroidism symptoms (2):

• Tiredness and decreased energy
• Swollen or puffy appearance
• Weight gain without increased appetite
• Slower growth rate
• Sore muscles
• Constipation
• Dry skin
• Brittle and dry hair
• Depression

Younger children may have delayed tooth development and short limbs (owing to a slower growth rate)(7)

. Meanwhile, older children may have delayed pubertal development and irregular or heavy menstrual periods. Children may also have increased sensitivity to cold (8).

Quick fact

Slow pulse, muscle cramps, thinning or falling off the sides of eyebrows, dull facial expressions, hoarse voice, slow speech, droopy eyelids, and a visibly enlarged thyroid are some more signs of hypothyroidism in children (6).

Types Of Hypothyroidism In Children

Hypothyroidism is mainly of three types (9) (10)

1. Primary hypothyroidism occurs when the thyroid gland cannot produce enough thyroid hormone on its own.

2. Secondary (central) hypothyroidism occurs when the thyroid gland is normal, but the pituitary gland in the brain, which regulates growth and sexual development, functions abnormally.

3. Tertiary hypothyroidism occurs due to a dysfunctional hypothalamus in the brain, which maintains the homeostasisⁱAbility of an organism to retain stable internal conditions in accordance with the external changes. of the body.

Hypothyroidism in children can be further subdivided as

1. Hypothyroidism present at birth, which includes:

• Congenital hypothyroidism (CH): It is caused by fetal thyroid gland underdevelopment or dysfunction. It is a common illness that affects one in 4,000 to 5,000 babies born in the US. Due to its high prevalence, CH testing is included in newborn screening programs in all the US states (6) (11).
  Recalling her daughter’s diagnosis of congenital hypothyroidism, Mandi, a mother of three, says, “He (the pediatric endocrinologist) walked in and explained that based on Margot’s (her nine-day-old daughter) newborn screen, she was being diagnosed with congenital hypothyroidism. A normal THL number for her thyroid would be 0.8, and hers was about 178. He didn’t even repeat blood work to make sure; he immediately started her on a daily thyroid medication that she would require for the rest of her life. He also explained that this occurs in 1 of 4,000 babies and predominantly in females, and how nothing I did or did not do during my pregnancy caused this to happen; it just occurs during fetal development (i).”
• Transient hypothyroidism: It is caused by exposure to thyroid medication or the mother’s antibodies because of maternal hypothyroidism. It normally resolves on its own without requiring long-term therapy (1).

2. 2. Acquired hypothyroidism develops after birth, usually during late childhood or adolescence. Depending on the underlying cause, it can be further divided into autoimmune hypothyroidism and iatrogenic hypothyroidismⁱA thyroid gland dysfunction induced by a medication or a surgical treatment. (6).

3. 3. Subclinical hypothyroidism is hypothyroidism discovered at an early stage when the TSH is slightly higher than usual but the T3 and T4 levels are normal. Subclinical hypothyroidism is characterized by the absence of symptoms and major health consequences. It could be identified if your child experiences goiter or weight gain or has a significant family history of thyroid disease. It often resolves without medication (8)

Risks Factors For Hypothyroidism In Children

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The following are some risk factors that may predispose your child to develop hypothyroidism (4) (12):

• • History of thyroid problems, such as goiter (caused by insufficient iodine intake)
  • An autoimmune disorder, such as type 1 diabetes or celiac disease
  • History of surgery to correct a thyroid problem
  • History of radiation treatment to the thyroid gland, head, neck, or chest
  • Family history of thyroid disorders
  • A chromosomal disorder such as Williams syndromeⁱA genetic condition caused by the deletion of specific regions on chromosome 7, leading to various physical and cognitive defects. , Down syndrome, or Turner syndromeⁱA chromosomal abnormality characterized by a single X chromosome in females.
  • Thyroid gland injury
  • Premature birth (7)

Causes Of Hypothyroidism In Children

The cause of hypothyroidism decides the type of hypothyroidism your child may be diagnosed with. Some causes of hypothyroidism in children include (6) (8):

1. Autoimmune disorders, such as chronic lymphocytic thyroiditis (CLT) or Hashimoto’s thyroiditis, may cause autoimmune hypothyroidism, where the immune system attacks the thyroid gland, causing impaired thyroid function. CLT affects girls and teenagers more than boys and pre-adolescents. According to a meta-analysis published in Frontiers in Public Health, the prevalence of Hashimoto’s thyroiditis in North America was found to be 7.8%.

2. Surgical removal or medical ablation of your child’s thyroid gland (or part of it) can cause iatrogenic hypothyroidism as their body can no longer produce thyroid hormones.

3. Thyroiditis (inflammation of the thyroid gland) due to a viral infection can leak stored thyroid hormones, causing hyperthyroidism for a short time before the thyroid gland becomes underactive (hypothyroidism).

4. Radiation treatment to the neck or head for conditions such as Grave’s disease can destroy or injure the thyroid gland, causing thyroid hormone dysfunction.

5. Medicines such as Amiodarone, Lithium, Interferon-alpha, and Interleukin-2 can decrease thyroid hormone production

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6. Damage to the pituitary gland may lead to insufficient TSH production, subsequently causing hypothyroidism.

Diagnosis Of Hypothyroidism In Children

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To diagnose hypothyroidism in children, your doctor may require (6) (13)

• Your child’s symptoms
• Your child’s medical and family history
• A physical examination
• Bloods tests or thyroid function tests to check the TSH and T4 levels in the blood
• Thyroid imaging tests, such as a thyroid scan, ultrasound, or radioactive iodine uptake test

Point to consider

Children who failed the thyroid portion as a part of their newborn screening, those with poor linear growth, and those who underwent cranial radiation for cancer treatment should be screened for the condition (6).

Treatment For Hypothyroidism In Children

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The purpose of hypothyroidism treatment is to restore the hormone levels to normal and support your child’s normal growth and development, depending on their age, overall health, and other factors. Your child may be referred to a pediatric endocrinologist, who treats children with hormonal problems (4).

The treatment mainly includes taking thyroid hormone replacement pills, such as Levothyroxine (T4 only) pills once daily, to boost the level of thyroid hormones in the body, also known as replacement therapy. Levothyroxine may be taken in the morning before food.

Your child may need to take these synthetic thyroid hormone pills lifelong (such as for iatrogenic hypothyroidism) or until their growth and puberty are complete. During the treatment, your healthcare provider will regularly check your child’s blood to see if the treatment is working, and their growth and development will be tracked over time (7).

Additionally, supplements such as calcium, iron, and vitamins are contraindicated with Levothyroxine and should be avoided during thyroid replacement therapy (8).

Complications Of Hypothyroidism In Children

Although hypothyroidism can be effectively managed with medication, if left undiagnosed or untreated, it can lead to various complications in children, including (5) (7) (10)

• Low levels of red blood cells (RBCs) (anemia)
• Low body temperature
• Heart failure or slower heart rate (bradycardia)
• Nervous system issues, such as lower IQ, speech delay, and impaired motor skills
• High cholesterol (hypercholesterolemia)
• Stunted physical growth or short stature
• Mental retardation
• Myxedema coma, where the body’s activities slow down to a point where it becomes life-threatening (rare)
• Cognitive impairment
• Hearing loss and eye problems

Infographic: Can A Specific Diet Cure Hypothyroidism In Children?

There are no specific foods or dietary supplements to cure hypothyroidism and other thyroid disorders in children. Limiting excess calorie intake and changing a sedentary lifestyle could benefit maintaining a healthy weight. Go through the infographic to learn facts about the hypothyroidism diet to maintain a healthy weight.

Illustration: Momjunction Design Team

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Learn about hypothyroidism in children and its causes, symptoms, and treatments. Get the facts to help your child live a healthy life.

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Dr. Arva M BhavnagarwalaMBBS, DNB

Dr. Arva Bhavnagarwala did her post-graduation from Masina Hospital in Mumbai and worked at Jaslok Hospital and Research Center as a Clinical Associate. With seven years of experience, she currently practices pediatrics at her private clinic in South Mumbai and is attached to Masina Hospital as a consultant pediatrician.

Read full bio of Dr. Arva M Bhavnagarwala

Reshmi DasMSc

Reshmi Das has over four years of experience as a clinical coordinator, medical content writer and medical conference coordinator. Her continuous interest in medical journals and writing makes her write well-researched articles for MomJunction.

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Dr. Ritika ShahBDS, CLC

Dr. Ritika Shah is a certified lactation counsellor (CLC) from iNational Health Care Academy, Singapore and a dental surgeon with more than seven years of clinical experience across various cities in India. She did her graduation in Dentistry from KM Shah Dental College.

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Dr. Joyani DasM.Pharm, PhD

Dr. Joyani Das did her post-graduation from Birla Institute of Technology, Mesra and PhD in Pharmacology. Previously, she worked as an associate professor, faculty of Pharmacology, for two years. With her research background in preclinical studies and a zeal for scientific writing, she joined MomJunction as a health writer.

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