Dr. Shaila S Bhattacharyya

Hypothyroidism is when the thyroid gland does not produce enough thyroid hormones. These hormones are crucial for growth, development and metabolism. In children, congenital hypothyroidism (hypothyroidism from birth) can lead to both physical and mental growth if not detected in first 2 weeks of life.

The most common causes of hypothyroidism in children include congenital hypothyroidism (present at birth), autoimmune thyroiditis (Hashimoto's disease), iodine deficiency (if not taking iodised salt) and rarely due to certain medications or medical treatments. Congenital hypothyroidism can occur due to partial or complete absence of thyroid gland or due to defective hormone production.

Symptoms can vary by age. During Infancy: prolonged jaundice, poor feeding, constipation and large tongue. Children and Adolescents: Fatigue, weight gain, cold intolerance, constipation, dry skin, short stature, poor schoolastic performance,delayed /precocious puberty and irregular periods. Sometimes symptoms may be subtle and go unnoticed.

Hypothyroidism is diagnosed by a blood test measuring thyroid-stimulating hormone (TSH) levels and free thyroxine (fT4). High TSH and low fT4 levels usually indicate hypothyroidism. Newborn screening programs often detect congenital hypothyroidism early. TSH assay is done on either cord blood or heel prick blood test on 3rd or 4th day of birth. If found abnormal repeat blood test, ultrasound thyroid and technecium scan of thyroid is performed to make a definitive diagnosis for the cause of hypothyroidism.

The treatment for hypothyroidism is daily administration of the synthetic thyroid hormone, levothyroxine. It is administered on empty stomach in the morning with minimum water and give one hour gap before eating or drinking. This medication helps to normalize thyroid hormone levels and helps in growth and good brain development. Regular monitoring and dosage adjustments by a healthcare provider are necessary to ensure effective treatment.

In many cases, yes, especially if the hypothyroidism is due to aplasia or hypoplasia of thyroid gland and dyshormonogenesis. Some children with transient hypothyroidism due to temporary conditions may eventually stop medication. Thyroid medicine is stopped at 3 yrs of age, once brain development is completed and child is re assessed 6 to 8 weeks later to see if child has permanent hypothyroidism.

When taken at the correct dosage, levothyroxine is generally safe and free from side effects. However, if the dose is too high, it may cause symptoms of hyperthyroidism, such as increased heart rate, weight loss, and nervousness. Regular monitoring helps prevent these issues.

If congenital hypothyroidism, initially, frequent visits (1-2 monthly until 6 months and 3monthly from 6 to 36 months ) are required to adjust the medication dose. Once the appropriate dose is established, visits may be spaced out to every 3 to 4 months, depending on your child's specific needs and response to treatment.

If left untreated, hypothyroidism can significantly impact growth and development, leading to short stature, delayed puberty, and cognitive impairments. However, with early diagnosis and appropriate treatment, most children with hypothyroidism can achieve normal growth and intelligence.

Children with hypothyroidism can usually lead normal lives without significant lifestyle changes. It’s important to ensure they take their medication consistently and maintain regular follow-up appointments. A balanced diet and regular physical activity benefit overall health but are not specific to hypothyroidism.

If a dose is missed, give it as soon as you remember. If it is close to the time for the next dose, skip the missed dose and resume the regular schedule. Do not double the dose. Consult your healthcare provider for specific advice.

While congenital and autoimmune forms of hypothyroidism cannot be prevented, ensuring adequate iodine intake during pregnancy can reduce the risk of hypothyroidism due to iodine deficiency. Newborn screening programs help in the early detection and management of congenital hypothyroidism.

The most common cause of hyperthyroidism in children is Graves' disease, an autoimmune disorder where the immune system attacks the thyroid gland, causing it to overproduce thyroid hormone. Other causes include thyroid nodules and inflammation of the thyroid gland (thyroiditis).

Symptoms can vary but often include: Rapid or irregular heartbeat/ weight loss despite normal or increased appetite/anxiety/nervousness or irritability/tremors in the hands/increased sweating/difficulty sleeping/ enlarged thyroid gland (goiter)/ frequent bowel movements/ fatigue and muscle weakness

Hyperthyroidism is rare in children and should always be diagnosed properly and treated by specialist. Usually treated with betablocker for sympathetic symptoms and neomercazole or methimazole for hyperthyroidism. Close watch for growth and side effects of the medication should be done.