You may worry that your child is shorter than her friends and doesn’t seem to have the same energy. She’ll sit and color, for instance, rather than join in a game of tag. These concerns aren’t unusual. But taken together with symptoms like constipation, dry skin and feeling cold, they could signal a problem with the thyroid gland.
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This bow-tie shaped gland at the base of the neck produces hormones that are critical for kids’ physical and mental development. So when a child’s growth is slow, a sluggish thyroid gland is one possible cause a pediatrician will consider.
“Parents who recognize these symptoms should see their pediatrician, who will decide whether their child needs thyroid or other tests,” notes pediatric endocrinologist Roy Kim, MD, MPH. “If the pediatrician suspects or finds a thyroid condition, they should see a pediatric endocrinologist.”
An underactive thyroid gland doesn’t make enough hormone. The condition, called hypothyroidism, or low thyroid, may be acquired (developing between ages 2 and 18) or congenital (present at birth).
What causes acquired hypothyroidism?
The main cause of acquired hypothyroidism is Hashimoto’s thyroiditis, in which the immune system mistakenly attacks cells in the thyroid gland and weakens it.
Hashimoto’s affects up to 1 in 100 children, making acquired hypothyroidism far more common than congenital hypothyroidism.
“Hashimoto’s thyroiditis can cause slow growth in children,” notes Dr. Kim. “Its other symptoms — constipation, low energy, feeling cold, dry skin and high cholesterol — are the same symptoms you see in adults.”
Your pediatrician will take a family history, because when another family member has hypothyroidism, a child’s risk increases.
They will also examine your child, because an enlarged thyroid gland is another clue pointing to hypothyroidism. The pediatrician may then order a blood test to confirm or rule out a problem with the thyroid.
What causes congenital hypothyroidism?
Congenital hypothyroidism, which affects about 1 in 4,000 newborns, is considered one of the more common congenital conditions.
The baby’s thyroid gland may be underdeveloped, missing or in the wrong place. Or it may not make enough thyroid hormone.
“Newborns with congenital hypothyroidism can look perfectly healthy and happy,” says Dr. Kim. “Symptoms don’t emerge until they’re found to grow poorly or have developmental delays.” (In other words, they may learn to sit, walk, talk and learn words later than usual.)
In severe cases, babies can feed poorly, and have prolonged jaundice and poor muscle tone.
The good news is that in the United States, congenital hypothyroidism is picked up on newborn screens, and treatment prevents babies from having these problems.
Do children ever outgrow hypothyroidism?
Although hypothyroidism doesn’t go away, treatment does successfully relieve symptoms.
Kids with acquired or congenital hypothyroidism are treated the same way as adults: with levothyroxine (Synthroid®, Levoxyl®, Unithroid®) — a synthetic thyroid hormone that replaces the natural hormone their thyroid can’t make.
“Levothyroxine works extremely well in children,” notes Dr. Kim. “It keeps their growth normal, and it keeps their puberty on track. It allows teenage girls to have regular periods.”
However, he stresses, replacing thyroid hormone only helps when the gland is underactive: “Plenty of kids can have constipation, dry skin or irregular periods that may be due to causes not related to the thyroid.”
Hashimoto’s usually requires lifelong treatment, although some children may need it only temporarily. Treatment for congenital hypothyroidism is lifelong.
Can thyroid problems affect kids’ behavior?
Since your thyroid gland helps to run your metabolism, when kids make too much or too little thyroid hormone, it can impact their activity and behavior.
“Without treatment, children who are hypothyroid can become passive and sit around,” explains Dr. Kim. “But when you replace the hormone their body needs and normally makes, they typically start having more energy and moving around more.”
The opposite problem occurs when a child’s dose of levothyroxine is too high, or when the body makes too much thyroid hormone (hyperthyroidism). Then kids may become hyperactive and unable to sit still, with sleeping difficulties and more impulsive behavior.
Thus, regular tests to check thyroid hormone levels are critical for children on levothyroxine.
“If your child needs treatment, work with your pediatric endocrinologist,” advises Dr. Kim. “Take the medicine very consistently, and get follow-up blood tests regularly.”
And you won’t have to worry about a sluggish thyroid slowing down your kid.
