Hypothyroidism is a common endocrine disorder in which your child’s thyroid gland does not produce enough thyroid hormone. A child with an underactive thyroid may experience fatigue, weight gain, constipation, decreased growth, and a host of other issues. Show
Your child’s thyroid is a small, butterfly-shaped gland in the front of the neck, just below the thyroid cartilage (Adam’s apple). Hormones produced by the thyroid affect all aspects of your child’s health including heart rate, energy metabolism (how effectively the body uses calories), growth and development. Hypothyroidism is treatable with medication. There are several different types of hypothyroidism, including: Congenital hypothyroidismCongenital hypothyroidism (CH) occurs when the thyroid gland does not develop or function normally prior to birth. It is a very common problem, affecting about 1 in every 2,500 to 3,000 babies. In the United States, all states test for CH as part of their routine newborn screening process. Many factors, including your family history, your child’s physical exam, the degree of hypothyroidism in your baby at the time of diagnosis, and the course of treatment over the first two to three years of life, will help your child's physician determine if the cause is hereditary (runs in your family), and if life-long therapy is required. Autoimmune hypothyroidism: chronic lymphocytic thyroiditisAcquired hypothyroidism is most frequently caused by an autoimmune disorder called chronic lymphocytic thyroiditis (CLT). In this disorder your child’s immune system attacks the thyroid gland, leading to damage and decreased function. The disorder was originally described by Japanese physician Hakaru Hashimoto and thus is often referred to by his name: Hashimoto’s thyroiditis. CLT is more common in girls than in boys, and in adolescents more than pre-adolescents. Patients with other forms of autoimmune disease, most commonly insulin-dependent diabetes, are at increased risk of developing CLT. Overall, about 20 to 30 percent of diabetics will develop CLT. Because of this, annual screening for CLT is a routine part of diabetic care. Iatrogenic hypothyroidismIatrogenic hypothyroidism is a form of acquired hypothyroidism that occurs in children who have had their thyroid gland medically ablated (destroyed) or surgically removed. By removing the thyroid gland, the body no longer produces thyroid hormone, leading to iatrogenic hypothyroidism. Central hypothyroidismCentral hypothyroidism occurs when the brain does not make thyroid-stimulating hormone (TSH), the signal that tells the thyroid gland to work. This condition is much less common than disorders associated with an abnormal thyroid gland. In fact, in central hypothyroidism, most patients have a normal thyroid. In addition to a low TSH, central hypothyroidism may be associated with deficiencies of other hormones, including:
Central hypothyroidism may occur due to abnormal development of the hypothalamus or pituitary glands (the location in the brain where TSH is made), trauma, a tumor or treatment for a tumor (i.e. surgery, radiation). Central hypothyroidism may be inherited, and boys and girls are affected equally.
Symptoms of hypothyroidism are usually subtle and gradual, and may resemble those of other conditions or medical problems. Many symptoms are non-specific and may be ignored as normal parts of our everyday lives. Because of this, the condition may go undetected for years. Symptoms may include:
If you have concerns about your child's health, talk to your child’s physician. Hypothyroidism can be congenital (meaning your child was born with it) or acquired as your child grows. Genetics do play a role and some children — although not all — inherit the disorder from their parents. In some cases, the cause of hypothyroidism is unknown. Depending on the cause of your child’s hypothyroidism, your child may be diagnosed with a specific type of hypothyroidism, which can affect treatment and long-term outcomes for your child. Severe hypothyroidism can lead to decreased metabolism and decreased use of calories. However, hypothyroidism is very rarely the cause of being overweight or obese. Despite this reality, medical providers often order thyroid function tests as part of the routine screening in overweight patients. This is a reasonable practice. In addition, thyroid function testing should also be ordered at the same time as testing for elevated cholesterol, as hypothyroidism is associated with elevated LDL levels (“bad” cholesterol) due to decreased metabolism of LDL. Being overweight is associated with mild elevations in thyroid-stimulating hormone (TSH) that are not a reflection of thyroid disease, but an association with excess weight. In other words, it is more common for excess weight to lead to a mild increase in TSH rather than a mild increase in TSH to result in a significant increase in weight. In order to confirm the relationship between excess weight and a mild increase in TSH, your child's doctor should review the linear growth (gain in height) to determine if the increase in weight is accompanied by normal or increased height, as opposed to decreased linear growth, which is more frequently associated with hypothyroidism. Your child’s doctor may also order laboratory testing for Hashimoto’s thyroiditis or elevated LDL and total cholesterol to determine whether the hypothyroidism should be treated. During the first few months of pregnancy, the fetus relies on the mother for thyroid hormone. Thyroid hormone plays an essential part in normal brain development. Maternal hypothyroidism can cause irreversible harm to the fetus. Early studies found that children born to mothers with hypothyroidism during pregnancy had lower IQ and impaired psychomotor (mental and motor) development. If properly controlled, often by increasing the amount of thyroid hormone, women with hypothyroidism can have healthy, unaffected babies. Current recommendations include asking all women at the initial prenatal visit if they have any history of thyroid dysfunction or thyroid hormone medication. Laboratory screening of thyroid functions and/or thyroid antibodies should be considered for women at high risk of hypothyroidism. Detection and treatment of maternal hypothyroidism early in pregnancy may prevent the harmful effects of maternal hypothyroidism on the fetus. For women on thyroid hormone prior to conception, thyroid function testing should be performed regularly throughout pregnancy as it is very likely that the thyroid hormone dose will need to be increased. Women are encouraged to ask their primary care providers for further information and clarification on this important topic. Diagnostic evaluation begins with a thorough medical history and physical examination of your child. The most common cause of congenital hypothyroidism is that the thyroid gland did not move to the correct location in the lower third of the neck during prenatal development. At The Children’s Hospital of Philadelphia, clinical experts use a variety of diagnostic tests to diagnose hypothyroidism, including:
Who should be screened for hypothyroidism?
At The Children’s Hospital of Philadelphia, experts at the Pediatric Thyroid Center take a team approach to treatment for children with hypothyroidism. Our board-certified endocrinologists, pediatric surgeons and nurses collaborate to provide your child with individualized care and the best possible outcome. Our Center is led by Andrew J. Bauer, MD, FAAP, a world-renowned endocrinologist and researcher, who is often sought for second opinions on difficult-to-diagnose thyroid disorders. In most cases, hypothyroidism can be treated with thyroid hormone replacement pills (levothyroxine). Levothyroxine is chemically identical to thyroxine (T4), which occurs naturally in our bodies, and replenishes your child’s thyroid hormone levels to normal as long as it is taken as prescribed. The pills can be given to patients of all ages, from newborn to adult. Uncommonly, patients may benefit from using both levothyroxine (T4) and liothyronine (T3). This option will be evaluated and discussed with you depending on your child's response to T4-only therapy, as well as your child's follow-up thyroid hormone laboratory values. If your baby has hypothyroidism and medication is prescribed, you can crush the tablet and give it to your baby with breast milk, formula or water. Currently, there is no liquid form of the medication in the United States that is effective. Older children can swallow or chew the medicine. Food can decrease the absorption, but in general, it is more important to remember to take the pill at about the same time every day (morning or night) than to be overly concerned about taking it on an empty stomach. You should avoid giving the thyroid replacement pill to your child at the same time they are ingesting iron or calcium. The majority of children with hypothyroidism — who are compliant with their medication — can achieve normal growth and development. Thyroid hormone replacement is weight- and age-based, so more frequent checks are needed while your child is still physically growing. Which finding would the nurse assess in a patient with hypothyroidism?Based on the assessment data, the nursing diagnoses appropriate for a patient with hypothyroidism are: Activity intolerance related to fatigue and depressed cognitive process. Risk for imbalanced body temperature related to cold intolerance. Constipation related to depressed gastrointestinal function.
Which causes of hypothyroidism result from a decrease in thyroid tissue?In some cases, hypothyroidism is a result of decreased production of thyroid-stimulating hormone (TSH) by the pituitary gland (called secondary hypothyroidism).
Which of the following are common cardiac signs with hyperthyroidism?Palpitations, exercise intolerance, dyspnoea, angina-like chest pain, peripheral oedema and congestive heart failure are common symptoms of hyperthyroidism [1, 2] that could show cardiovascular involvement of this relatively frequent endocrinological disorder.
Which condition should a nurse expect to find in a client diagnosed with hyperparathyroidism?Explanation: The nurse should know the parathyroid glands regulate serum calcium levels; in hyperparathyroidism, serum calcium levels are elevated.
|