#ITAW20: The mischievous thyroid gland: Part 2

As the international thyroid awareness week comes to an end, I bring forth a less common yet potentially serious disease of the thyroid that affects the children. 

Hypothyroidism makes oneself slowdown and weary. In contrast hyperthyroidism gets one moving at a high speed, but for no good. It gets the heart pounding faster than ever, the brain nervous and the gut stirring.

While an overactive thyroid is far less common than hypothyroidism and rare in children, it does occur and has adverse effects on the child’s health. 

As opposed to hypothyroidism, the levels of the thyroid hormones T3 (Triiodothyronine) and T4 (Thyroxine) are raised in a patient with hyperthyroidism and the metabolic rate is increased. 

What causes a hyperactive thyroid gland?

There could be a range of causes due to which a thyroid gland may be overactive. But the most common of these is the Graves disease. 

Graves disease is an autoimmune condition, where autoantibodies (antibodies that attack one’s own tissues) act on the thyroid gland and stimulate it similar to the thyroid-stimulating hormone, TSH, and makes it function continually.

Apart from this a nodule or tumor in the thyroid gland (producing excess thyroid hormones) or the master gland pituitary (producing excess TSH) can cause hyperthyroidism.

When to suspect a child may have hyperthyroidism?

The symptoms may be subtle in the initial stage and more marked as the disease advances. The following features should raise an alarm

  • Loss of weight despite increased appetite
  • Sweating 
  • Palpitations
  • A feeling of excessive heat
  • Diarrhea
  • Swelling in front of the neck
  • Menstrual abnormalities in adolescent females
  • Nervousness, anxiety
  • Sleeplessness
  • Prominent eyes with or without pain
  • Tremors in hands

What are the complications?

Heart failure 

Rhythm disturbances of the heart

Psychosis

An eye disease called Graves ophthalmopathy

How is the diagnosis of hyperthyroidism confirmed?

The doctor orders a simple blood investigation, the thyroid function test. In the case of Graves disease, the hormone levels of T3 and T4 will be elevated, while the TSH levels are suppressed. 

Apart from this, if required the doctor may order a few more investigations viz. TRAb (TSH receptor antibodies) and a nuclear imaging study of the thyroid gland, to figure out what exactly is causing the gland to hyperfunction.

These investigations may however not be required in all cases. 

How to control the hyper-functioning gland?

Different treatment options are available 

  1. Medications which lower the hormonal levels called antithyroid drugs, (methimazole), 
  2. Radioiodine ablation of the thyroid gland and 
  3. Surgery: thyroidectomy or removal of the thyroid gland.

 Each has its advantages and disadvantages; therefore your pediatric endocrinologist decides which treatment best suits your child, depending upon the disease status, the age of the child. 

How long should the child be treated?

The duration of treatment depends upon the therapeutic modality used. Since surgery and radioiodine therapy are ablative procedures, they provide a permanent cure to hyperthyroidism, but the patient requires replacement with levothyroxine.

 On the other hand, those on oral medications may require treatment for a few years, which depends upon the response to therapy.

Moreover, Graves’ disease can recur after successful treatment with antithyroid drugs and their cessation. In such a scenario, treatment is restarted and consideration is given to other modalities of treatment to achieve permanent cure.

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