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Hypothyroidism

Hypothyroidism
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Located in the neck, the thyroid gland is responsible for producing a range of hormones that regulate the body's metabolism (chemical reactions in the body that help it function and grow). Hypothyroidism (underactive thyroid) occurs when the thyroid gland does not produce enough of these hormones, specifically triiodothyronine (T3) and thyroxine (T4).

There are two types of hypothyroidism that affect children:

  • Congenital hypothyroidism. Congenital hypothyroidism is present at birth. This condition is not hereditary. There are many reasons why this condition may develop. They are:
    • The thyroid gland does not develop properly in utero (it is missing, too small or located in the wrong place).
    • The thyroid gland develops properly but does not produce enough hormones.
    • The thyroid gland develops properly but does not receive the right signals from the pituitary gland (the gland located at the base of the brain that controls the thyroid gland).
    • The thyroid gland develops properly but is suppressed by medicines the mother takes while pregnant (typically to treat hyperthyroidism). This cause of congenital hypothyroidism may be temporary.

If left untreated, congenital hypothyroidism can cause an intellectual disability or delayed growth. Because the condition often shows no symptoms during the first week of life, all U.S. hospitals screen newborns for the condition before they go home.

  • Acquired hypothyroidism. Acquired hypothyroidism can develop at any age. The most common cause of acquired hypothyroidism in children and teenagers is a direct attack on the thyroid gland by the immune system (called Hashimoto thyroiditis). Other causes include:
    • Damage to the thyroid gland by radiation therapy for cancer
    • Damage to the thyroid gland after surgery for thyroid cancer, hyperthyroidism or a goiter
    • Damage to the pituitary gland by a severe brain injury or radiation therapy for cancer
    • Too much or too little iodine in the diet
    • Medicines that interfere with thyroid hormone production such as lithium and some cancer and infection fighting medicines

Children and teenagers with some other disorders are at a greater risk for acquired hypothyroidism—especially those with Down syndrome and Type 1 diabetes.

Symptoms of congenital hypothyroidism may include:

  • Weak cry
  • Feeding problems
  • Sleeping significantly more hours than the average infant
  • Constipation
  • Jaundice (yellowing of the skin and whites of the eyes)
  • Poor muscle strength
  • Puffy face
  • Large tongue
  • Swollen stomach
  • Fontanelles (soft spots) that are abnormally large

Symptoms of both congenital and acquired hypothyroidism may include:

  • Extreme fatigue
  • Feeling cold
  • Dry skin
  • Hair loss
  • Modest weight gain (5-10 pounds)
  • Constipation
  • Failure to thrive

Diagnosis of Hypothyroidism

Your child's doctor at Riley at IU Health can use the following exams or tests to diagnose hypothyroidism:

  • Physical exam. Your child's doctor can feel the thyroid by physically examining the neck. An enlarged thyroid gland may indicate a thyroid problem.
  • Blood tests. A blood test can check the level of hormones produced by the thyroid and pituitary glands. Low levels of hormones produced by the thyroid indicate hypothyroidism.
  • Imaging scan. The doctor may order an imaging scan to see if the thyroid gland is missing or too small.

Treatments

Treatments

If your child is diagnosed with hypothyroidism, his or her treatment plan will include:

  • Medicine. Your child will take a medicine called levothyroxine, most likely for the rest of his or her life. Levothyroxine is a synthetic thyroid hormone that replaces the function of thyroxine (the naturally occurring hormone that the thyroid cannot produce enough of).
  • Continued monitoring. Your child should visit his or her doctor periodically for continued monitoring of thyroid function. The doctor will perform a blood test to make sure the medicine treatment is working and adjust dosage if needed.

With proper treatment, children with hypothyroidism can live a normal, healthy life.

Key Points to Remember

Key Points to Remember

  • Congenital hypothyroidism is present at birth. Newborns are screened for the condition before being discharged from the hospital.
  • Congenital hypothyroidism occurs when the thyroid gland is small, missing, underdeveloped or not working as it should.
  • Acquired hypothyroidism can occur at any age.
  • The most common cause of acquired hypothyroidism in children and teens is Hashimoto thyroiditis.
  • A child with hypothyroidism can live a normal, healthy life by taking a medicine called levothyroxine.

Support Services & Resources

Support Services & Resources

Visit the links below to learn more about hypothyroidism and discover support groups and resources.

Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.

Learn More About Riley Support Services

Pediatric Endocrine Society

The Pediatric Endocrine Society provides printable fact sheets that explain the causes, symptoms, diagnosis and treatment of acquired hypothyroidism and congenital hypothyroidism.

MedlinePlus

Learn more about hypothyroidism on this website by the U.S. National Library of Medicine.

Departments Treating This Condition

Departments Treating This Condition

  • Diabetes & Endocrinology
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