Treatment And Follow Up
Once hypothyroidism has been diagnosed, your child will need to start treatment and will almost certainly stay on this for the rest of their life. Treatment with thyroxin is relatively straight forward and is given as a tablet taken once a day by mouth.
It is very important that your child receives their thyroxine treatment regularly.
What is The Outcome for Children with Congenital Hypothyroidism ?
Compared to the years before screening, there has been a dramatic improvement in the outcome for children with hypothyroidism. Their progress was compared with a large group of children who did not have hypothyroidism. Severe learning difficulties in children with hypothyroidism were very unusual unless there were other complicating factors. Most children with hypothyroidism will attend mainstream schools although a small number may have special educational needs.
Acquired Hypothyroidism
When the thyroid gland becomes under-active in later childhood, this is called late onset or acquired hypothyroidism. The most common cause is an autoimmune process whereby the body’s tissues are gradually destroyed by its own antibodies. Autoimmune problems result in a number of different types of thyroid disorders, including Hashimoto’s disease, and they are tested for by measuring the auto-antibodies in the blood.
- Growth problems
Children with acquired hypothyroidism may have slow growth associated with a tendency to put on weight. If there is a problem with excessive weight gain, even though growth appears normal, it may be worth rechecking thyroid levels in the blood. Slow growth can be the only symptom of an under-active thyroid and may be detected during regular growth monitoring by health visitors or school nurses.
However, if tests show that the thyroid gland is working properly, and yet growth is still slow, this may need further investigation and a referral to a specialist. In children with untreated hypothyroidism, the onset of puberty is often delayed although in very severe cases precocious puberty can develop. In either case, some treatment may be appropriate.
- Physical Changes
Children with hypothyroidism may develop a gradual change in facial appearance, but this may only be apparent by looking back at old photographs. The face may develop a rather pale, puffy appearance caused by the accumulation under the skin of a watery fatty substance called myxoedema. Occasionally fluid develops in other places such as the chest cavity. Other changes may include constipation, a slow heart rate, some hair loss and slow reflexes.
- School, behaviour and personality
One of the surprising things about acquired hypothyroidism is how little change there is in school performance. There may be some increased sleepiness but this does not usually become a major problem. For this reason parents often do not identify the problem, or seek medical help, until the physical changes are apparent. Thus the thyroid hormone deficiency may have remained undetected for some time, particularly as tiredness and sleepiness may be considered as normal behaviour. Once treated, your child may become much more lively and outgoing than when they were untreated!
When a diagnosis of hypothyroidism is suspected, the doctor may need to undertake some further tests to confirm the diagnosis. Hypothyroidism can affect bone maturation and taking an X-ray of the left hand and wrist to look at the maturation of the bones can assess this. From this a doctor can see whether skeletal development is delayed, in line with, or advanced compared to your child’s chronological (actual) age. In hypothyroidism, the bone age is often quite delayed compared to the chronological age.
Because of slow growth, it is likely that your child’s height will be more appropriate for their bone age than their chronological age. When replacement thyroid hormone treatment is started, their growth will accelerate and enable them to ‘Catch up” their height and skeletal development and so their final height should not be affected. Only if the diagnosis is made very late, and a child is therefore not treated for many years, will final height be affected.
Hyperthyroidism
When the thyroid gland becomes overactive and secretes excess thyroid hormone, this is known as hypethyroidism or thyrotoxicosis. These two terms are almost the same and are often used interchangeably. Hyperthyroidism and hypothyroidism are often confused because of the similarity of the words. However great care is needed as they are very different and the treatments are very different.
What is the Cause of Hyperthyroidism?
By far the most common form of hyperthyroidism is a condition called Graves’s diseases, after the Irish doctor, Robert Graves, who first described it. Hyperthyroidism may be caused by overactivity of the gland, a hormone secreting benign tumour of the thyroid, or Graves diseases in which there are additional symptoms including swelling of the neck (goiter) due to enlargement of the gland, and protrusion of the eyes.
In Grave’s disease, the over activity of the gland is caused by abnormal production of antibodies which stimulate the TSH receptors in the thyroid. This in turn leads to excessive production of thyroid hormones by the thyroid gland. The tendency to produce there antibodies often runs in families and it is common for children with hyperthyroidism to have a brother or sister, parents or other close relatives with either hypo or hyperthyroidism.
There is a rare form of hyperthyroidism that develops soon after birth (neonatal hyperthyroidism). This is caused by antibodies crossing the placenta from the mother, which over-stimulate the baby’s thyroid gland. In babies who do have hyperthyroidism, the thyroid is usually enlarged and the baby may have typical symptoms such as a rapid heart rate, irritability and mild diarrhea. This is a temporary condition that resolves within 3 to 6 months. Some treatment may be required but there are no long-term problems. Although many pregnant women do have and overactive thyroid, the condition in babies is surprisingly rare.
Other causes of hyperthyroidism are very rare. There are some syndromes associated with hyperthyroidism, such as the McCune-Albright Syndrome where there is also irregular skin pigmentation, precocious puberty and bone problems. Viral ifections or inflammation of the thyroid (thyroiditis) can also cause hyperthyroidism.
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