Symptoms, signs and treatment of hypothyroidism in children

Hypothyroidism is a condition in which the thyroid gland does not produce the required quantities of its hormones-thyroxine and triiodothyronine. The disease can be either congenital (present since birth) or acquired (occurring later in life).

Congenital hypothyroidism also called as cretinism can be due to several mechanisms. The thyroid gland may not develop at all (agencies of thyroid gland) or not develop fully (hypoplasia). It can be due to deficiency of iodine or deficiency of enzymes necessary for the synthesis of thyroid hormones.

Clinical features: The condition may be obvious at birth or manifest after a few weeks. These babies are overweight, have a hoarse cry and do not cry much. Constipation is extremely common. Other features are umbilical hernia, thick protruding tongue and hypothermia (decreased body temperate). The skin feels course unlike the soft and silky skin of normal babies.

Diagnosis: It is extremely important to diagnose congenital hypothyroidism at the earliest so that prompt treatment can be started. Thyroid hormone is indispensable for the normal growth and maturation of the nervous system. Delay in starting treatment can result in irreversible mental retardation.

In those places where hypothyroidism is common all newborn babies are screened for this condition. In other places a high degree of suspicion is required to detect even mild deficiency. Thyroid function tests should be done if a newborn baby has any of the above features.

The levels of Thyroid (T4),Triiodothyronine (T3) and Thyroid stimulating Hormone (T.S.H.) are estimated. TSH is produced by the pituitary gland which controls the functions of all other endocrine glands.

In hypothyroidism the levels of T3 and T4 are decreased. If the problem is with the thyroid gland (primary hypothyroidism) the level of TSH will be high as the pituitary gland tries to stimulate the thyroid gland to produce more hormones.

If on the other hand there is some problem with the pituitary gland the level of TSH will also be low (secondary hypothyroidism). In such a situation the levels of other pituitary hormones should also be estimated.

Treatment: This should be started without delay. Thyroxine is available for oral administration. A dose of 10 micrograms/kg is needed to ensure normal levels of thyroid hormones. It is necessary to regularly check the hormone levels in the blood. Dose has to be increased as the child grows older. Treatment should be continued lifelong.

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