Thyroid Disorders in Children
What are thyroid disorders?
The thyroid is a small, butterfly-shaped gland located at the front of the neck. It produces hormones that help regulate growth, metabolism, energy levels, body temperature and brain development. When the thyroid does not produce the right amount of hormone, it can affect many aspects of a child's health and development.
Thyroid disorders are among the most common endocrine conditions seen in children. Some children have an underactive thyroid (hypothyroidism), while others develop an overactive thyroid (hyperthyroidism). Less commonly, children may develop an enlarged thyroid gland (goitre) or a thyroid nodule.
With early diagnosis and appropriate treatment, most children with thyroid disorders go on to lead healthy, active lives.
What are the symptoms of thyroid disorders?
The symptoms depend on whether the thyroid is producing too little or too much hormone.
Underactive thyroid (Hypothyroidism)
Children with hypothyroidism may experience:
- Tiredness or low energy
- Slow growth
- Weight gain despite no major change in diet
- Constipation
- Dry skin
- Feeling unusually cold
- Poor concentration
- Delayed puberty
- Slower growth or delayed development
Symptoms often develop gradually and can be difficult to recognise initially.
Overactive thyroid (Hyperthyroidism)
Children with hyperthyroidism may experience:
- Weight loss despite a normal or increased appetite
- Feeling hot or sweating excessively
- A fast heartbeat or palpitations
- Anxiety or irritability
- Difficulty sleeping
- Tremor (shaking hands)
- Frequent bowel movements
- Difficulty concentrating
- Rapid growth in some children
Some children with hyperthyroidism also develop prominent eyes, particularly if the cause is Graves' disease.
Goitre and thyroid nodules
An enlarged thyroid (goitre) may appear as swelling at the front of the neck. Most goitres are painless but should always be assessed.
Thyroid nodules (small lumps within the thyroid) are uncommon in children but require specialist assessment to determine whether further investigation is needed.
When should I seek medical advice?
You should consider arranging an assessment if your child has:
- Persistent tiredness without an obvious cause
- Unexplained changes in weight
- Slow growth or delayed puberty
- Symptoms of an overactive thyroid, such as weight loss, tremor or a fast heartbeat
- Swelling or a lump at the front of the neck
- A family history of thyroid disease alongside concerning symptoms
Although thyroid disorders are uncommon, early diagnosis can prevent complications and help ensure normal growth and development.
What causes thyroid disorders?
There are several possible causes of thyroid disease in children.
These include:
- Autoimmune thyroid disease (the most common cause of both hypothyroidism and hyperthyroidism)
- Congenital hypothyroidism (present from birth)
- Inflammation of the thyroid gland (thyroiditis)
- Iodine deficiency (rare in the UK)
- Genetic conditions
- Thyroid nodules or cysts
- Rarely, thyroid tumours
The most common causes are Hashimoto's thyroiditis, which usually leads to hypothyroidism, and Graves' disease, which causes hyperthyroidism.
How are thyroid disorders diagnosed?
Your child's consultation will begin with a detailed discussion about their symptoms, growth and medical history, followed by a physical examination.
Investigations may include:
- Blood tests to measure thyroid hormone levels (TSH and free T4)
- Thyroid antibody tests
- Ultrasound scan of the thyroid gland
- Additional blood tests if appropriate
Most children can be diagnosed with a simple blood test, although imaging may be recommended if there is swelling of the thyroid or a thyroid nodule.
What treatment is available?
Treatment depends on the specific thyroid condition.
Underactive thyroid
Hypothyroidism is usually treated with levothyroxine, a synthetic thyroid hormone taken as a daily tablet. Most children respond very well, and regular blood tests are used to adjust the dose as they grow.
Overactive thyroid
Hyperthyroidism is commonly treated with medication that reduces thyroid hormone production. In selected cases, surgery or radioactive iodine treatment may be considered, although these are less common in children.
Goitre and thyroid nodules
Treatment depends on the underlying cause. Some children only require monitoring, while others may need medication, further investigations or, occasionally, surgery.
Your endocrinologist will explain the diagnosis and recommend the most appropriate treatment for your child.
Long-term outlook
Most thyroid disorders can be managed very successfully with ongoing treatment and regular follow-up.
Children receiving appropriate treatment generally experience normal growth, development and puberty, and can participate fully in school, sports and everyday activities.
Regular monitoring is important because hormone requirements often change as children grow.