#ITAW20: The mischievous thyroid gland: Part 1

Twelve-year-old Daisy (name changed) was brought to me with a concern that she was not growing well over the last 2 years. Her mother also noticed that she was least interested to play around with friends and had grown “fatter”. She received complaints from the school teacher that her academic performance was deteriorating over time. The father was extremely anxious as Daisy was a bright student and always had good grades in exams.

While I listened to her parents speak, the look on Daisy’s face hit the right chord with me and I had clinched the diagnosis. Nevertheless, I was eager to hear from Daisy and she mumbled with her hoarse voice, “I feel sleepy all day.” I placed my hand on hers and said, “Don’t worry, you will be alright.” Her hands were cold and I felt her radial artery pounding at the pace of a snail.

Over the last 2 years, the parents thought their child was a “slow grower” and did not seek medical advice. It wasn’t their neglect, but the lack of knowledge that kept them from understanding what Daisy’s symptoms were pointing towards and seeking medical attention. The declining grades at school brought them to me at that point.

I got her thyroid function test and there we had the diagnosis of hypothyroidism.

The world is observing May 25th to May 31st, 2020 as the International thyroid awareness week. As the name speaks, the campaign was initiated to promote awareness on thyroid illnesses and this blog post is my bit towards the cause.

What is the thyroid gland and why is it important?

The thyroid gland is a butterfly-shaped endocrine gland present in front of the neck, that releases hormones called thyroxine and triiodothyronine, commonly called the T4 and T3 respectively.

The hormones have important functions in every human being which includes metabolism (energy production), maintaining body temperature, growth, and development, particularly of the brain and bone.

Thyroid hormone is crucial for brain development in fetal life and early childhood up to the age of 3 years. Impaired thyroid functioning during these critical periods can have permanent adverse effects on the child.

Hundreds of millions of people worldwide are affected by one or the other kind of thyroid illness and more than half of them are unaware of it.

Though thyroid disorders are far more common in adults than in children, the impact of a malfunctioning gland in a child is much more significant as inadequate hormones cause hindrances in growth and development.

Since the thyroid is one of the important engines that keep the body running, any affection to its functioning can significantly impact the productivity of an individual and thereby negatively influence society.

Thyroid illnesses affect children or adults of any age and range from an underactive thyroid gland that can make you lazy and listless or an overactive gland that keeps you nervous and tired.

The manifestations are subtle early on, obvious and debilitating in advanced stages.

Thyroid malignancies are quite common in the elderly, rarely though affecting the kids as well.

And the tricky thing here is, in most cases, the correct history and examination by an expert, one simple blood test, the thyroid function test is all that finds the culprit and a single pill makes all the difference.

Read below to find out more about hypothyroidism in children.

What causes hypothyroidism in a child?

Hypothyroidism developing during childhood maybe

  • Congenital: due to a defect in the thyroid gland present since birth. It may be diagnosed early during the newborn period or later in life when the thyroid gland is partially functioning.

Read my previous post on congenital hypothyroidism to know more @ http://drsapnanayak.com/2020/05/the-tale-of-the-thyroid-gland/

  • Acquired: The cause of deficient hormone here is an insult to the thyroid gland that happens during the later years after birth.

Most commonly, the gland gets destroyed by an autoimmune process and the condition is called Hashimoto’s thyroiditis.

Less often, the damage may be due to surgery, radiation to the thyroid gland, or iodine deficiency.

How to recognize hypothyroidism?

  • You notice your child is short and has a poor growth rate
  • Weight gain despite low appetite
  • Constipation
  • Excessive sleepiness
  • Fatigue and decreased energy to play
  • Poor academic performance
  • Early or delayed onset of puberty.
  • Generally onset of puberty(marked by breast development in girls and testicular enlargement in boys occurs between 8-13 years and 9-14 years respectively).
  • Menstrual abnormalities in adolescent females
  • Dry skin
  • Brittle hair
  • Swelling in front of the neck.

Which child is likely to develop hypothyroidism?

Hypothyroidism may sporadically affect any child.

The female gender and the presence of autoimmune thyroid disease in the parent increase the risk. It is often not possible to predict whether a given child may be affected or not.

However, certain other factors that place a child at increased risk are.

  1. A child with certain chromosomal disorders viz. Down syndrome, Turner syndrome, etc
  2. A child with other autoimmune conditions viz. type 1 diabetes mellitus, celiac disease.
  3. A child who has undergone radiation to the head or neck

These children are subjected to periodic screening (often annually) without waiting for obvious symptoms to develop.

“Do I need to worry if my child had a normal newborn screening test?”

Newborn screening is done to recognize and start early treatment for the babies who are affected with severe congenital hypothyroidism and are on the verge of serious brain damage.

Rarely mild cases may not be picked up in the screening program, depending upon the cut off levels of TSH used.

Moreover, a normal newborn screening result does not imply he/she is immune to any cause of acquired hypothyroidism.

Therefore, despite a normal newborn screen, if an older age, you find the symptoms of hypothyroidism in your child, don’t stop yourself from seeing the specialist. 

Is hypothyroidism curable?

It may not be possible to eliminate or rectify the root cause of hypothyroidism in a child which may be a congenital malformation or an autoimmune disorder.

However, the treatment is simple and just consists of intake of a tiny pill once every day to replace the deficient hormones for the rest of the life, along with periodic check with the doctor to ensure that your child is receiving the right dose.

Thank you for reading through till the end of this post. Do not hesitate to leave your comments and queries.

Share the information and be a part of the awareness campaign.

Do join me back on the part 2 of this post.

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