Thyroid Disease in Kids: The Most Important Things to Know

While the thyroid is small compared to the rest of the body, it has a big job to do. This tiny, butterfly-shaped gland located at the base of the neck produces thyroid hormone, which is critical for neurocognitive development as well as growth and metabolism.

It’s often not on parents’ radars unless one of them also has thyroid disease. The good news is that most pediatricians are on the lookout for it at well-check visits, and due to the location, they can examine the gland fairly easily. So be sure to keep those appointments!

Thyroid disease is not uncommon in kids and the symptoms can be vague. Because of this, I’d like to help increase awareness and understanding of it. Here are the most important things to know about thyroid disease in children:

Thyroid Disease in Kids: The Most Important Things to Know

1. What it is

There are three main types of thyroid disorders: hypothyroidism, hyperthyroidism and thyroid nodules.

• Hypothyroidism, or an underactive thyroid, can be either congenital or acquired. Congenital means that it is present at birth. When a baby has this condition, the thyroid is not making enough hormones for the brain and body to grow and develop normally. Screening for congenital hypothyroidism happens in all newborns shortly after birth. Acquired hypothyroidism develops later in life, most commonly in the teenage years.  Hypothyroidism can cause children to feel tired, gain weight, have abnormal menstrual cycles, cause constipation and slow growth.
• Hyperthyroidism happens when the thyroid makes too much thyroid hormone. This most commonly occurs in adolescents. Symptoms of hyperthyroidism include unexplained weight loss, diarrhea, increased heart rate, irritability, and trouble sleeping.
• A thyroid nodule is a mass in the thyroid gland. Occasionally nodules can produce extra thyroid hormone and cause symptoms of hyperthyroidism, but usually they are not hormone producing. Most nodules are found when they are palpated during an exam of the neck, so it is important that the pediatrician assess this at each yearly well visit. A small number of nodules can be cancerous and will require surgery and further treatment.  Thyroid cancer occurs in about 10 out of 100,000 kids ages 1-18. The good news is that kids with this type of cancer overall have good outcomes with treatment. 

2. How it’s diagnosed

We use blood work to check how much thyroid hormone the gland is producing. Utilizing ultrasound is the best way to image the thyroid gland and does not use radiation. An iodine uptake scan, which is a nuclear medicine study, can also be used to help determine if the thyroid gland is making hormone normally.

3. How it’s treated

In general, thyroid disease responds well to treatment. For hypothyroidism, physicians will prescribe an oral medication called levothyroxine, which is the same as the thyroid hormone the body makes. For hyperthyroidism, your child’s doctor can prescribe a drug to reduce thyroid hormone production. In some patients, surgical removal of the gland or radio-iodine ablation is a better option. Surgical removal can treat thyroid nodules and thyroid cancer. Additional therapy with radio-iodine may be needed for some patients with thyroid cancer.  Often endocrinology, radiology, and ENT will work together to determine the best plan for treatment and monitoring of thyroid disease.

4. Who’s at risk

The most common cause of hypo- and hyper-thyroidism is autoimmune.  This means that the immune system produces antibodies that cause abnormal thyroid function.  Teenage females appear to be at highest risk and we also tend to see autoimmune disease run in families.  Children who have very restrictive diets or who are dependent on TPN for nutrition may have iodine deficiency.  Normal thyroid hormone production requires iodine, so these kids are at risk for hypothyroidism. Children who have received radiation to the head or neck (such as for treatment of brain tumors) are at risk for developing thyroid cancer and should have thorough neck exams performed regularly.

If you have any concerns about your child’s thyroid, please contact his or her pediatrician. If there is concern for thyroid disease the doctor will make a referral to a pediatric endocrinologist.