Hypothyroidism in children

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Hypothyroidism in children is an endocrine disease in which thyroid hormones are poorly secreted by the thyroid gland or these hormones do not affect the cells. In children, hypothyroidism is manifested by weakness, inhibition, muscle hypotonia, delayed tooth extraction, delayed eruption of gums, growth retardation, and mental developmental delay. In order to detect hypothyroidism in children at an early stage, it is necessary to conduct a screening test for TTG hormone, T4, thyroglobulin, antithyroid antibodies. In addition, ultrasound examination of the thyroid gland (ultrasound) and scintigraphy. Hormone replacement drugs are used to treat hypothyroidism in children.

Hypothyroidism in children is a pathological condition characterized by a deficiency of thyroid hormones. Thyroid hormones include thyroxine (T4), triiodothyronine (T3), and thyrocalcitonin. During the first weeks of pregnancy, the embryo is exposed to thyroid hormones in the mother's body. pregnancyBy 10 to 12 weeks, thyroid gland is formed in the embryo. Thyroid hormones are synthesized in special cells of the thyroid gland - thyrocytes, which capture and retain free iodine from the blood plasma. Thyroid hormones are essential for normal growth in a child’s life. Thyroid hormones control the process of embryogenesis: the formation of bone tissue, the formation and development of the hematopoietic system, the respiratory organs and the immune system, play an important role in brain growth.

Deficiency of thyroid hormones in children leads to serious complications. The younger the child, the more dangerous this pathology. In children, hypothyroidism causes stunted physical and mental development (growth, mental ability), metabolic disorders (protein, fat, carbohydrate, calcium) and thermoregulatory disorders.

Classification of hypothyroidism in children

Hypothyroidism in children can be congenital and acquired. In cases of congenital hypothyroidism, children are born with thyroid hormone deficiency. Based on pediatric endocrinology data, the incidence of congenital hypothyroidism was found in 4 in 5 to 1 infants (twice as common in girls as in boys).

In children, the symptoms of hypothyroidism are transient (transient), subclinical, manifest. There are primary (thyrogenic), secondary (pituitary) and tertiary (hypothalamic) forms depending on the degree of thyroid hormone production disorder.

Causes of hypothyroidism in children

In children, hypothyroidism develops as a result of defects in the hypothalamic-pituitary-thyroid system. In 10-20% of cases, the cause of congenital hypothyroidism may be a gene with a past anomaly inherited from the parents. However, in most cases, congenital hypothyroidism is considered to be accidental.

Primary hypothyroidism occurs mainly in children, in which pathology is observed in the thyroid gland itself. This can be due to congenital defects of the thyroid gland, aplasia, hypoplasia, or dystopia.

Adverse environmental factors (radiation, insufficient iodine in the diet), fetal infection, intrauterine infection, taking certain drugs during pregnancy (thyrostatics, tranquilizers, bromides, lithium salts), autoimmune thyroiditis in the mother , causing endemic goiter.

In 10-15% of cases, hypothyroidism in children is caused by a violation of the synthesis of thyroid hormones and the lack of receptors in the cell that can recognize these hormones.

Congenital pituitary or hypothalamic defects in children with secondary and tertiary hypothyroidism are caused by a genetic defect in the synthesis of the hormone TTG. Acquired hypothyroidism in children occurs as a result of pituitary or thyroid inflammatory disease, tumors, trauma or surgery, endemic iodine deficiency.

Symptoms of hypothyroidism in children

Hypothyroidism can occur in infants with the following symptoms:

• Late delivery (at 40-42 weeks);

• The child is overweight (above 3,5-4 kg);

• Face, eyebrows, tongue (macroglossia), large fingers and toes;

• Difficulty breathing, low and rough crying.

In newborns, hypothyroidism is accompanied by prolonged jaundice, late healing of umbilical ulcers, umbilical hernias, weak suction reflex.

Symptoms of hypothyroidism also worsen as the child grows. Symptoms may be less pronounced due to the baby being breastfed, as the baby also absorbs thyroid hormones from the mother’s body through milk. Symptoms of hypothyroidism in children of breast age are manifested by a delay in somatic and psychomotor development: general weakness, drowsiness, muscle hypotonia, inhibition, hypodynamics, stunted height and body weight, large size of the larynx and their late onset , late eruption of teeth, lack of formation of abilities (holding the head, sitting, standing, walking).

In addition, children with hypothyroidism develop bradypsychia: low interest in the environment, slow reactions to sound, the child does not make noise, does not play, has difficulty communicating. It also causes damage to the heart muscle, weakened immunity, paleness and dryness of the skin, brittle hair, low body temperature, anemia, constipation.

The onset of symptoms of hypothyroidism depends on its etiology and severity of the disease. The danger of hypothyroidism in the early stages of pregnancy is that this pathology can lead to irreversible damage to the MNT (central nervous system), mental weakness, bone deformities, stuttering, mood swings, loss of hearing and speech, and underdevelopment of the gonads.

In children, in the mild form of hypothyroidism, symptoms may not appear or appear late, that is, between the ages of 2-6 years, sometimes during puberty. If hypothyroidism occurs in children over 2 years of age, no serious impairments by mental ability are observed. Symptoms of hypothyroidism in older children may include obesity, stunting, and delayed sexual maturation, mood disorders, slowed thinking ability, and retardation in assimilation.

Diagnosis of hypothyroidism in children

To detect primary congenital hypothyroidism, of course, a screening examination in the field of pediatrics is carried out (within 4-5 days after birth). The amount of TTG in the blood plasma, the level of hormone synthesis in the thyroid gland is studied. In addition, a general and free T4, T3, thyroglobulin and antithyroid antibody, index of bound thyroid hormones, thyroliberin test are performed to differentiate the type of hypothyroidism.

In the diagnosis of hypothyroidism, subsequent ultrasound examination of the thyroid gland (ultrasound) and scintigraphy are used. Such examinations indicate anatomical abnormalities (incomplete formation, deformation) of the organ, a decrease in its functional activity. X-ray examination may also be ordered to determine the degree of ossification.

Treatment of hypothyroidism in children

Treatment of hypothyroidism in children - should be carried out at an early stage with the diagnosis of the disease. (within 1-2 weeks after delivery), then the risk of serious complications is reduced.

In most cases, for the treatment of congenital or acquired hypothyroidism - lifelong hormone replacement drugs are prescribed. In addition, vitamins, nootropics, therapeutic massage are also recommended. In subclinical manifestations of the disease, it is possible not to use drugs, patients are always under medical supervision.

Consequences and prevention of hypothyroidism in children

The outcome of hypothyroidism in children depends on the age of the child, the severity of the disease, the duration of treatment and the correct dose of medication. In children who receive timely treatment, mental maturity may return to normal.

Failure to treat hypothyroidism can lead to irreversible processes in the child and cause the child to become disabled.

Children suffering from hypothyroidism should always be under the supervision of a local pediatrician, pediatric endocrinologist and neuropathologist.

Prevention of hypothyroidism in children includes the consumption of iodine-rich products by a pregnant woman or taking iodine-containing drugs under medical supervision. Early detection of iodine deficiency in children and treatment based on their elimination is necessary.