Thyroid problems are not rare in children, but they are not as common as parents usually believe. For example, only about five percent of patients with hyperthyroidism are under fifteen years old.
Especially when their kids are overweight though, parents often think that their kids must have a hormonal problem or that something is wrong with their thyroid gland. However, while children with thyroid problems can be overweight, it is important to keep in mind that these children are typically short, while kids who are overweight because they eat too much or exercise too little are usually tall.
Sleeping a lot is another common symptom that bring parents to their pediatrician looking for a thyroid problem. While that symptom usually deserves looking at your child's thyroid function tests, without other symptoms, they are likely to be normal and you might look for obstructive sleep apnea, depression, mono, etc., as other possible causes.
This is not to say that kids can't get thyroid problems.
From congenital hypothyroidism and Hashimoto's thyroiditis to Graves disease, children and teens can indeed develop thyroid problems.
Reviewing some of the common signs and symptoms of hypothyroidism and hyperthyroidism can help you to know when to get thyroid function tests ordered for your child and when to look for another cause for your child's symptoms.
Symptoms of Hypothyroidism
Hypothyroidism most commonly occurs when the thyroid gland isn't producing enough thyroid hormone, either because it can't (primary hypothyroidism) or because it isn't being stimulated properly (secondary hypothyroidism).
Kids with primary hypothyroidism will usually have a low free thyroxine level (free T4) and an elevated level of thyroid stimulating hormone (TSH) and associated symptoms of hypothyroidism, such as:
- short stature or deceleration of growth
- rough, dry skin
- cold intolerance
- fatigue, decreased energy
- sleeping more
- easy bruising
- delayed bone age on xray
- delayed puberty (teens)
- galactorrhea (white breast discharge)
- pseudoprecocious puberty (early puberty)
- vision problems
Newborns with congenital hypothyroidism are usually identified on their newborn screening test, which routinely tests for hypothyroidism.
Symptoms of Hyperthyroidism
In hyperthyroidism, also called thyrotoxicosis, there is an excess of thyroid hormones. These children will usually have a high T4, T3, and a low TSH.
Symptoms of hyperthyroidism can include:
- emotional lability, with your child being more likely to cry easily, be irritable and excitable, etc.
- short attention span
- finger tremor
- increased appetite
- weight loss, failure to thrive
- enlarged thyroid gland (goiter)
- exophthalmos (protruding eyes)
- upper eyelid lag
- infrequent blinking
- flushed skin
- excessive sweating
- muscle weakness
- tachycardia and palpitation
- high blood pressure
Whether you think your child's thyroid is underactive or overactive, talk to your pediatrician if you think his thyroid isn't working properly. As thyroid disorders are sometimes hard to diagnose and thyroid function tests can sometimes be hard to interpret, an evaluation by a pediatric endocrinologist can also be helpful.
Behrman: Nelson Textbook of Pediatrics, 19th ed.
Melmed: Williams Textbook of Endocrinology, 12th ed.