Hypothyroidism in children
The content of the article:
- Forms of the disease
- Causes and risk factors
- Symptoms of hypothyroidism in children
- Diagnostics
- Treatment of hypothyroidism in children
- Potential consequences and complications
- Forecast
- Prevention
Hypothyroidism in children is a disease based on insufficient secretion of thyroid hormones (thyrocalcitonin, triiodothyronine and thyroxine) by thyroid cells.
The thyroid gland begins to function at 11-12 weeks of embryonic development. Thyrocytes (thyroid cells) capture free iodine from the plasma and accumulate it, using it in the synthesis of thyroid hormones. These hormones are essential for the proper development of a child. They are especially important in the antenatal period (from the moment of fertilization of the egg to the birth of a child) and in the first months after birth, since they regulate the formation and maturation of brain structures and, above all, the cerebral cortex, as well as the immune, respiratory, hematopoietic systems …
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Hypothyroidism in children is much more serious than in adults. The younger the child, the greater the danger the thyroid hormone deficiency poses to his health. This condition leads to a violation of protein, carbohydrate, fat and mineral metabolism, a disorder of thermoregulation processes, and a delay in psychomotor development (growth, intelligence, puberty).
Forms of the disease
Hypothyroidism is classified as congenital or acquired. Congenital hypothyroidism in children occurs with a frequency of 1 in 5,000 newborns. The incidence of boys is 2 times lower than that of girls.
According to the severity of clinical signs of lack of thyroid hormones, manifest, transient (transient) and subclinical hypothyroidism in children is distinguished.
Depending on the level at which there was a violation of the production of thyroid hormones, the following forms of hypothyroidism are distinguished:
- primary (thyrogenic) - caused by direct damage to the thyroid tissue, characterized by an increase in the level of TSH (thyroid stimulating hormone);
- secondary (hypothalamic-pituitary) - associated with damage to the hypothalamus and / or pituitary gland, which is accompanied by insufficient secretion of thyroid-stimulating hormone and thyroliberin, followed by a decrease in the functions of the thyroid gland.
Causes and risk factors
The reasons for the development of hypothyroidism in children are various dysfunctions of the hypothalamic-pituitary-thyroid system. In about 20% of cases, the occurrence of hypothyroidism in children is associated with genetic abnormalities, inherited or arising spontaneously. Among the genetically determined forms of the disease, congenital myxedema (cretinism) is most common.
Another cause of congenital hypothyroidism in children is malformations of the thyroid gland (hypoplasia, aplasia, dystopia), which can be provoked by intrauterine infections, as well as a number of negative factors affecting the body of a pregnant woman:
- iodine deficiency;
- ionizing radiation;
- therapy with lithium salts, bromides, tranquilizers, thyreostatics;
- endemic goiter;
- autoimmune thyroiditis.
Secondary forms of congenital hypothyroidism in children are associated with anomalies in the development of the hypothalamus and / or pituitary gland.
Acquired hypothyroidism in children is much less common. The reasons for its occurrence can be:
- endemic iodine deficiency;
- damage to the thyroid gland or pituitary gland caused by a tumor or inflammatory process, trauma, surgery.
Symptoms of hypothyroidism in children
During the neonatal period, the symptoms of hypothyroidism in children are mild. These include:
- post-term pregnancy;
- the weight of the newborn is more than 4 kg;
- swelling of the fingers and toes, face, tongue (macroglossia);
- rude crying;
- heavy intermittent breathing;
- protracted course of transient jaundice;
- weak sucking reflex;
- umbilical hernia;
- long-term healing of the umbilical wound.
As children grow and develop, the symptoms of hypothyroidism become more prominent. In breastfed babies, the onset of signs of hypothyroidism occurs more slowly than in artificially fed babies. This is due to the fact that maternal thyroid hormones are present in small amounts in breast milk. Symptoms of hypothyroidism in infants are:
- late closure of the large fontanelle;
- lethargy, lethargy, drowsiness;
- muscle hypotension;
- hypodynamia;
- lag in weight gain and growth;
- violation of the term and order of teething;
- delay in the formation of skills (holding the head, self-turning, sitting).
A characteristic sign of hypothyroidism in children is the formation of bradypsychia - poor vocal and emotional reactions, indifference to the environment. A sick child has poor contact with close people, cannot play on his own, his speech development is delayed (lack of humming, pronunciation of syllables). Other manifestations of pathology:
- a tendency to constipation;
- anemia;
- low body temperature;
- increased hair fragility;
- dryness and pallor of the skin;
- decreased immunity;
- myocardial damage.
Lack of thyroid hormones in the early stages of embryonic development leads to irreversible damage to the central nervous system, which causes:
- mental retardation;
- deformation of the skeleton;
- dwarfism;
- underdevelopment of the sex glands;
- speech and hearing impairments, up to their complete loss;
- mental disorders.
With a slight deficiency of thyroid hormones, signs of the disease appear later, after the child reaches 2–5 years of age, and sometimes even with the onset of puberty.
Hypothyroidism that occurs in children over two years of age is not accompanied by severe mental impairment. In this case, the disease is accompanied by the following symptoms:
- slow thinking;
- lability of mood;
- delayed puberty and growth;
- obesity;
- decreased academic performance.
Diagnostics
For early detection of congenital hypothyroidism in children, a screening study of all newborns is carried out. On the 4-5th day of life, blood is taken to determine the concentration of thyroid-stimulating hormone. An increased level of this hormone requires further in-depth examination of the child, which includes determining the concentration:
- free and total thyroxine (T 4);
- total and free triiodothyronine (T 3);
- antithyroid antibodies;
- thyroglobulin.
In addition, a test with thyroliberin is performed and the thyroid hormone binding index is determined.
Instrumental examination methods:
- survey scintigraphy and ultrasound of the thyroid gland - allow you to identify possible developmental anomalies, decreased functional activity;
- X-ray of tubular bones and knee joints in order to determine the bone age of the child.
Treatment of hypothyroidism in children
With congenital hypothyroidism in children, treatment should begin in the first weeks of life. This helps prevent the occurrence of severe psychosomatic disorders in them.
Drug therapy for acquired and congenital hypothyroidism is carried out with synthetic analogues of thyroid hormones throughout the patient's life. The optimal dose of the hormonal drug is selected by the endocrinologist individually, taking into account the general condition of the child, the biochemical parameters of the blood, and the characteristics of the hormonal background.
In addition to hormone replacement therapy, the treatment of hypothyroidism in children includes nootropics, vitamins, as well as exercise therapy and massage.
Potential consequences and complications
If untreated, hypothyroidism in children can lead to the following complications:
- mental retardation of varying severity;
- delayed physical development;
- obesity;
- myxedema coma;
- increased susceptibility to infectious diseases;
- megacolon:
- pseudohyponatremia;
- normocytic normochromic anemia;
- hypoparathyroidism.
Forecast
With an early start of treatment, the prognosis is generally favorable. Hormone replacement therapy leads to rapid compensation for the condition of the sick child, and in the future, his psychomotor development occurs in accordance with age characteristics.
If substitution therapy is prescribed after the child has signs of cretinism, then it can only prevent their further progression. In such cases, the child has irreversible and profound changes leading to disability.
Children suffering from hypothyroidism are under constant supervision of an endocrinologist, pediatrician, and neuropathologist. At least once a quarter, they should determine the level of thyroid-stimulating hormone in the blood.
Prevention
Prevention of hypothyroidism in children includes the appointment of pregnant women, especially those living in areas endemic for iodine deficiency, iodine-containing preparations.
Diseases of the thyroid gland, accompanied by a hypothyroid state in pregnant women, require mandatory replacement therapy.
If congenital hypothyroidism is detected in children, immediate treatment is necessary, which prevents the development of irreversible changes and disability of patients.
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Elena Minkina Doctor anesthesiologist-resuscitator About the author
Education: graduated from the Tashkent State Medical Institute, specializing in general medicine in 1991. Repeatedly passed refresher courses.
Work experience: anesthesiologist-resuscitator of the city maternity complex, resuscitator of the hemodialysis department.
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
