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Hypothyroidism in children occurs when the thyroid gland does not produce enough thyroid hormones. This is a very treatable condition. Children with hypothyroidism may need to take hormone replacement medication and can go on to live full lives.

The thyroid gland affects nearly every system in the body, including the heart and brain. Without enough thyroid hormones, a child’s bodily functions slow down. Symptoms typically are mild, or there are no symptoms. If thyroid hormone levels drop low enough, symptoms such as fatigue become more noticeable.

Congenital hypothyroidism is a condition in which a baby is born with a low- or nonfunctioning thyroid. There are no symptoms, but if left untreated it can lead to permanent mental disabilities. Newborn screening for congenital hypothyroidism has greatly reduced the number of babies with the condition. Some babies are born with temporary hypothyroidism, which will go away by itself in the first weeks or months of life.

Children with congenital hypothyroidism likely will need hormone replacement medication for the rest of their life. Daily thyroid hormone replacement pills are a relatively simple solution. The patient will have to visit their endocrinologist several times a year for an exam, blood tests and possible medication adjustments.

In some children, hypothyroidism develops as they grow.

Depression and hypothyroidism have been linked through brain chemicals such as serotonin. Children with untreated hypothyroidism are at greater risk for depression and an increased risk of suicide.

Hypothyroidism and hyperthyroidism (an overactive thyroid) essentially are opposites of one another. Hypothyroidism is far more common. Both are equally serious conditions.

Pediatric endocrinologists treat hypothyroidism in children with medication that brings the body’s thyroid hormone levels back to where they need to be. Treatment can vary depending on the condition and child’s age.

Your pediatrician may refer you to a pediatric endocrinologist. These physicians specialize in treating hormone conditions in children.

Your child is in good hands. Our board-certified and fellowship-trained specialists at Norton Children’s Endocrinology, affiliated with the UofL School of Medicine, are some of the best in the country, according to U.S. News & World Report. We will work with you to create a care plan that is as unique as your child.

Hypothyroidism Symptoms in Children

When hypothyroidism causes symptoms, they can include:

  • Sluggishness
  • Depression
  • Dry skin or hair loss
  • Feeling cold
  • Muscle weakness
  • Poor memory or trouble concentrating
  • Constipation
  • Facial puffiness 
  • Weight gain (even when not eating more or exercising less)
  • Slowed growth
  • Slow sexual development
  • Irregular menstrual periods

Hypothyroidism also can cause obesity in children, but this is rare.

Causes of Acquired Hypothyroidism in Children

Hashimoto thyroiditis or chronic lymphocytic thyroiditis causes most cases of hypothyroidism in children. The immune system, which is supposed to fight infection, can sometimes attack the thyroid. The condition can trigger too much thyroid production as the gland fights back, but it also can cause the gland to make fewer thyroid hormones and cause hypothyroidism. Combined with swelling caused by the immune system, the thyroid can become enlarged and develop a goiter — a lump under the skin that is big enough to be visible and felt.

Genetics play a role in both congenital and acquired hypothyroidism in children, and in some cases the cause of hypothyroidism is unknown.

Diagnosing Hypothyroidism in Children

If a pediatric endocrinologist suspects your child may have hypothyroidism, they will conduct a physical exam and blood tests to diagnose it.

T4 Test

This test measures the blood level of the hormone T4 (thyroxine). Total T4 measures the entire amount of thyroxine in the blood, including the amount attached to blood proteins that help carry the hormone through the bloodstream.

Free T4 measures only the thyroxine that’s not attached to proteins. This is the part of T4 in the blood that affects how the body’s cells work.

TSH Test

A thyroid-stimulating hormone (TSH) test can help determine how well the thyroid is working. In cases of hyperthyroidism, the thyroid is making too many hormones and the pituitary gland releases less TSH, lowering the level of TSH in the blood.

T3 Total Test

This test measures the other major thyroid hormone in the blood.

Thyroid Antibodies Test

If the thyroid gland is under attack by Hashimoto thyroiditis, an autoimmune condition, high levels of antibodies are a sign of the immune system’s attack on proteins in the thyroid gland. Usually, two types of thyroid antibodies are measured: thyroglobulin antibodies (TgAb) and thyroid peroxidase (TPO) antibodies.

Abnormal thyroid test results can have causes other than disease and require an endocrinologist’s expertise to interpret the results.

Congenital Hypothyroidism Diagnosis and Symptoms

Newborn screenings in the United States have allowed for prompt diagnosis and treatment of congenital hypothyroidism before any long-term intellectual disabilities can occur. The screening is performed as part of several tests newborns receive before leaving the hospital. The screening involves a tiny needle prick to the newborn’s heel.

If the screening shows high levels of thyroid-stimulating hormone (TSH), which is made by the pituitary gland, and/or low levels of thyroxine (T4), made by the thyroid gland, doctors will do additional blood tests and perhaps an ultrasound of the thyroid to confirm a diagnosis.  

Sometimes a test can show an incorrect result of no hypothyroidism (false negative). One of the more common causes of this is preterm birth, in which the baby may not be producing enough TSH to trigger a positive result. Because of the possibility of false negative screenings and the potential consequences of congenital hypothyroidism, pediatricians are on the lookout for congenital hypothyroid symptoms as a baby develops.

Early signs of congenital hypothyroidism in a baby include:

  • Jaundice (yellow skin or eyes)
  • Sleeping longer or more often than usual
  • Constipation
  • Large soft spot on the head, called a fontanel
  • Large, swollen tongue
  • Weak or floppy muscle tone
  • Swelling around the eyes
  • Poor or slow growth
  • Cool, pale skin
  • Large belly with the navel sticking out

Most cases of congenital hypothyroidism happen because the thyroid doesn’t form correctly during pregnancy. At birth, the baby may have no thyroid gland at all or have a small, partially developed gland. The cause often is unknown, but sometimes there’s a genetic reason.

Less commonly, a baby’s thyroid did fully develop but can’t make enough thyroid hormones. This usually is due to a genetic condition.

Some babies are born with temporary hypothyroidism. This can be caused by premature birth, thyroid disease in the mother or medicines the mother took during pregnancy. This form of hypothyroidism usually goes away by itself in the first weeks or months of life.

If your baby’s doctor prescribes medication for hypothyroidism, they will see your child regularly to make sure the medicine is working and change the dose as your child grows. It’s important to go to all of these appointments to ensure your child has the hormones they need to develop properly.

Children with congenital hypothyroidism can sometimes develop hearing issues. If you have any concerns about hearing or speech development, talk to your doctor.

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