Hyperthyroidism in Children

Overview

Hyperthyroidism is a condition where the thyroid gland, located at the front of the neck, produces too much thyroid hormone. This gland plays a crucial role in regulating the body’s metabolism, which is how the body uses energy. In children, an overactive thyroid can lead to a range of symptoms that affect their growth, development, and overall health. Understanding hyperthyroidism in children is essential for parents, as early detection and treatment can significantly improve a child’s quality of life.

Symptoms

Hyperthyroidism can present a variety of symptoms in children, which may differ slightly from those in adults. Here are some common signs to watch for:

  • Rapid Heart Rate: Your child may experience a faster-than-normal heartbeat, even when resting.
  • Weight Loss: Despite a healthy appetite, your child might lose weight or struggle to gain weight as expected.
  • Increased Appetite: They may feel hungry all the time and eat more than usual.
  • Nervousness and Anxiety: Your child might appear unusually anxious, irritable, or restless.
  • Excessive Sweating: They may sweat more than usual, even in cool conditions.
  • Fatigue: Despite seeming restless or hyperactive, your child may tire easily and feel fatigued.
  • Tremors: You might notice slight shaking or trembling, especially in their hands.
  • Sleep Problems: Trouble falling asleep or staying asleep is common.
  • Heat Intolerance: Your child may complain about being too hot, even in a comfortable environment.
  • Increased Bowel Movements: Frequent bowel movements or diarrhea may occur.
  • Enlarged Thyroid Gland: You may notice a swelling in the neck, known as a goiter.
  • High blood pressure
  • Trouble concentrating, poor school performance
  • Staring/bulging eyes
  • Thyroid storm (or thyrotoxic crisis) 
    • a serious complication of hyperthyroidism. 
    • It occurs when a child’s thyroid hormone levels become severely elevated. 
    • Although thyroid storm is rare, it can be life threatening. 
    • The most important symptoms of thyroid storm are 
      • a high temperature 
      • changes in mental status (like confusion or lethargy). 
    • If you suspect your child may be experiencing thyroid storm, you should always seek immediate medical care.

Causes

Hyperthyroidism in children can be caused by several factors:

  • Graves’ Disease: 
      • In Graves’ disease, the body produces antibodies called thyroid-stimulating immunoglobulins (TSIs).
      • These antibodies mistakenly attach to the thyroid and stimulate it to produce more hormones than needed.
      • This overproduction leads to symptoms of hyperthyroidism.
  • Neonatal Graves’ Disease: 
      • Neonatal Graves’ disease is a rare condition affecting newborns, occurring in fewer than 1% of pediatric hyperthyroidism cases.
      • It happens when a mother with Graves’ disease passes TSIs to her baby during pregnancy.
  • Toxic Adenomas and Goiters: 
        • Rare in children, these are overactive thyroid nodules that produce excess thyroid hormone.
  • McCune-Albright Syndrome:
      • This rare condition causes hyperthyroidism along with other symptoms like fibrous bone growth and skin pigmentation.
      • It is due to a genetic mutation that causes certain cells to overproduce hormones.
  • Thyroiditis:
      • This condition often follows infections, autoimmune conditions, radiation exposure or certain medication 
      • This causes the thyroid to release too much hormone due to inflammation.
  • Chronic Lymphocytic Thyroiditis (Hashimoto’s Thyroiditis):
      • Hashimoto’s thyroiditis is another autoimmune thyroid disorder. 
      • It can cause a temporary phase of hyperthyroidism before leading to hypothyroidism (underactive thyroid) over time.

Diagnosis

Diagnosing hyperthyroidism in children involves several steps:

  • Medical History and Physical Exam: 
    • The doctor will ask about your child’s symptoms and perform a physical examination, checking for signs of hyperthyroidism.
  • Blood Tests: 
    • Blood tests are essential to measure levels of thyroid hormones (T3 and T4) and Thyroid Stimulating Hormone (TSH). High levels of T3 and T4, along with low levels of TSH, often indicate hyperthyroidism.
  • Thyroid Scan: 
    • scans using technetium 99m (99mTc) or iodine 123 (123I) can be helpful if the thyroid glands texture is uneven or if the cause of the thyroid issue is not clear.
  • Ultrasound: 
    • An ultrasound can provide detailed images of the thyroid gland, helping to detect nodules or enlargement.

Treatment Options

Treatment Approach for Pediatric Graves' Disease

When a child is diagnosed with Graves’ disease, it’s important to start treatment quickly. The type of treatment will depend on the child’s age and how severe the condition is. There are three main treatment options:

  • Antithyroid Medications: These help to control the overproduction of thyroid hormones. This option is considered safe, as long as the child or teen is ready to stick with the treatment for a longer period.
  • Radioiodine Ablation: This involves using radioactive iodine to shrink the thyroid gland.
  • Thyroidectomy: This is a surgical procedure to remove part or all of the thyroid gland.

Each of these treatments has its own benefits and drawbacks, so the choice of treatment will be tailored to what is best for the individual child.

Treatment Approaches for Neonatal Graves' Disease

  • Mild Cases: 
    • In less severe instances, doctors may use a medication called a beta-blocker (like propranolol). This helps manage symptoms such as rapid heartbeat and jitteriness. Often, this is enough because the condition in newborns is usually temporary.
  • Moderate to Severe Cases: 
    • If the condition is more serious, doctors will prescribe antithyroid medications. These drugs help reduce the production of thyroid hormones in the baby’s body.
  • Severe Cases: 
    • In very serious situations, doctors might use a type of iodine solution (like Lugol’s iodine or potassium iodide). 
    • This works quickly by preventing the thyroid gland from releasing too many hormones. 
    • In addition, glucocorticoids (a type of steroid) may be given to slow down the conversion of thyroid hormones in the body and to protect against adrenal gland problems.

Symptomatic Treatment

  • For certain types of hyperthyroidism that tend to go away on their own, like subacute thyroiditis, hyperthyroidism caused by too much iodine, or when too much thyroid hormone (T4) has been taken, treatment can focus on managing the symptoms rather than the underlying cause. 
  • If a child experiences significant heart-related symptoms, a medication called propranolol, which helps slow down the heart, can be very effective

Long-term Monitoring

  • If your child is being treated with medication for their thyroid condition, it’s important to keep a close eye on how well the treatment is working. This means having regular blood tests every 2 to 3 months to check the levels of thyroid hormones (T4, T3) and thyroid-stimulating hormone (TSH). 
  • These tests help the doctor make sure that your child’s thyroid is functioning properly and that the treatment is on the right track.

Activity level during treatment

  • Children with hyperthyroidism may feel restless or easily tired and might find it harder to engage in physical activities like they normally would. 
  • These symptoms usually get better once treatment starts working. 
  • Until your child’s thyroid levels are back to normal, it’s a good idea to limit their activity to what they can comfortably handle without feeling overly fatigued. Let their energy levels guide how much they do.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Hyperthyroidism. Here’s why families trust us:

“When our teenager was diagnosed with Waldenström's, we were shocked and scared. The team at Gertrude's Children's Hospital guided us through every step of the treatment process. Their expertise and compassionate care have given our child a chance at a healthy future.”

Davidfather of a Hyperthyroidism patient

Hyperthyroidism in Children

If you observe symptoms such as rapid heartbeat, weight loss, or excessive sweating in your child, it’s important to schedule an appointment with a pediatrician. Early diagnosis and treatment are crucial to managing the condition effectively.

Yes, if left untreated, hyperthyroidism can interfere with a child’s growth and development. However, with appropriate treatment, most children can lead healthy, normal lives.

With proper management, many children with hyperthyroidism do not experience long-term complications. However, ongoing monitoring is necessary to ensure that hormone levels remain balanced and to adjust treatment as needed.

In some cases, hyperthyroidism can be a chronic condition that requires long-term management. However, treatment can help control symptoms and maintain normal thyroid function.

Surgery is not always necessary. It is usually considered if medication and radioactive iodine therapy are not effective or if there are nodules on the thyroid gland that need to be removed.

Support your child by ensuring they take their medication as prescribed, attending all follow-up appointments, and maintaining a healthy lifestyle. Encourage them to express how they are feeling and be there to listen.

Contact Us

If your child is showing signs of hyperthyroidism, don’t wait to seek help. Early diagnosis and treatment can make a significant difference in managing this condition and ensuring your child’s overall health and well-being.

Contact us today to schedule an appointment or learn more about our Hyperthyroidism in Children treatment program:

Book Appointment