Hyperthyroidism in children

It's no secret that the thyroid gland plays a crucial role in the child's body: it is necessary to support the metabolism, for the normal growth and development of the child. Therefore, thyroid diseases are very dangerous for the health of the baby. The appearance of hyperthyroidism is associated with excessive production of thyroid hormone. And hyperthyroidism in children in most cases is due to the development of diffuse toxic goiter.

[1], [2], [3], [4], [5], [6], [7]

Causes of the hyperthyroidism in the child

To date, there are several possible factors of excessive thyroid function:

• hyperactivity of follicular cellular structures of glandular tissues, as a result of which a large number of triiodothyronine and thyroxine are produced;
• damage to the cellular structures of the thyroid gland with the release of accumulated hormones into the bloodstream;
• excessive use of iodine-containing drugs or hormonal agents, incorrect calculation of dosage.

The immediate causes of the disease can be:

• autoimmune thyroid disease, which is accompanied by excessive production of hormones;
• infectious or viral pathologies of the thyroid gland with destruction of the gland cells;
• nodal formations in the gland;
• tumor processes in the pituitary gland;
• tumor processes in the thyroid gland (eg, adenoma);
• some diseases of appendages;
• genetic predisposition to malfunctions in the thyroid gland.

[8], [9], [10], [11], [12], [13]

Pathogenesis

Stimulation of the thyroid gland to excess hormone production often occurs at the local level: glandular tissue grows due to internal pathologies, for example, the tumor process.

It is also possible systemic (center) stimulation, in which the excessive function of the thyroid gland is explained by the action of the hormones of the pituitary gland, the gland of internal secretion, the so-called appendage of the brain, which controls the function of the entire endocrine system. A pituitary can erroneously send an excessive number of signals to a normally working thyroid gland, and she, following these promises, begins to produce hormones in an accelerated mode.

In some cases, the receptor mechanism of the thyroid is stimulated not by the hormonal pituitary system. Blame all antibodies, produced by the body's own immune system against its own cells. This development of hyperthyroidism is called autoimmune - it is observed more often than others and is manifested by thyrotoxicosis or diffuse toxic goiter.

[14], [15], [16], [17], [18], [19], [20], [21], [22], [23]

Symptoms of the hyperthyroidism in the child

Hyperthyroidism in children develops in about 5% of all cases of the disease. The maximum number of cases is found in adolescence.

The clinical picture of the disease is not always the same, but the symptoms do not develop as rapidly as it occurs in adults. Symptoms gradually increase, the disease is diagnosed after about six months or a year from the moment of its onset.

The first signs in childhood are emotional instability on the background of increased motor activity. The child becomes easily excitable, capricious and irritable. At school, teachers note his inattention and deterioration in academic performance. If you ask the child to stretch out his arms, you can see a shiver in your fingers. Appetite is markedly increased, but there is no increase in body weight (sometimes even on the contrary - the baby loses weight). Shchitovidka increases, which is noticeable not only to the touch, but also visually. You can hear noises while listening.

Many children develop exophthalmos. Sometimes there are specific symptoms:

• Symptom Gref - when the upper eyelid is somewhat behind when looking down;
• a symptom of Mobius - a breakdown in convergence;
• Stewwag's symptom is a rare blink and retraction of the upper eyelid.

Skin covers are usually moist (due to increased sweating), reddened. Muscular weakness can be observed, up to a change in gait (clumsiness, stumbling). Heart palpitations, there is shortness of breath.

In advanced cases, systolic murmur, atrial fibrillation, is heard. Blood pressure may increase.

A child who has contracted hyperthyroidism, as a rule, is very tall. In sexual development, there are no differences from peers.

[24], [25], [26]

Complications and consequences

Hyperthyroidism, which began its development in the newborn period, as a rule, is temporary and self-eliminated for three months (rarely - several years). A later onset of the disease has not such a positive outlook.

One of the most dangerous complications of hyperthyroidism in children may be a thyrotoxic crisis, or a hyperthyroid coma. This condition can develop with medium to severe disease. Crisis contributes to any operations, improper treatment of the thyroid gland, systemic diseases, infectious pathologies.

Symptoms of thyrotoxic crisis are:

• sudden rise in temperature;
• general excitation, rapidly replaced by immobility;
• severe attack of vomiting, diarrhea, total loss of fluid;
• a sharp drop in blood pressure.

If the child does not receive help on time, then loss of consciousness, violation of cardiac activity and even death can occur.

Also, hyperthyroidism can lead to a violation of sexual function, which in the future can provoke problems with potency.

[27], [28], [29], [30], [31], [32], [33]

Diagnostics of the hyperthyroidism in the child

Diagnosis of the disease is carried out consistently and includes the following activities:

• general examination of the endocrinologist, collection of complaints, auscultation, palpation of the gland;
• blood tests for the content of thyroid hormones T3, T4 and thyroid-stimulating hormone;
• instrumental diagnostics - ultrasound examination of the thyroid gland, computed tomography, electrocardiography.

If you suspect a hyperthyroidism, the confirmation of the disease most often does not cause difficulties. Typical criteria are the appearance of the patient, his complaints and test results. Functional hyperactivity of the gland is easily confirmed by laboratory methods of investigation. First of all, the doctor must determine the level of thyroid hormones.

Timely diagnosis of hyperthyroidism plays a huge role in the effectiveness of the prescribed treatment.

[34], [35], [36], [37], [38]

Differential diagnosis

Differential diagnosis is carried out:

• with lymphocytic thyroiditis;
• with pheochromocytoma.

Treatment of the hyperthyroidism in the child

Unambiguously, the best way to treat hyperthyroidism in children is not: the therapeutic scheme is always chosen individually. Some doctors prefer surgical methods (subtotal thyroidectomy), while others perform medical therapy first.

Experts endocrinologists and radiotherapists do not recommend the appointment of a child in childhood radioactive iodine - this way of affecting the thyroid gland is now used mainly for patients after 50 years. Exceptions may be cases in which drugs do not have an effect, and surgical intervention is contraindicated.

Antithyroid drugs are often prescribed for Mercazolil and Propylthiouracil. These drugs block the passage of the inorganic iodine in the thyroid gland into the organic, as well as the transformation of T4 into T3. In addition, studies have shown that this inhibits the production of antithyroid autoantibodies.

The preliminary dose of Propylthiouracil can be from 100 to 150 mg three times a day, and Mercazolil is prescribed in an amount of 10-15 mg three times a day. Subsequently, the dosage can be increased or decreased, depending on the indications. The smaller the age of a child, the smaller the dose should be, since excessive intake of drugs into the body can result in hypothyroidism.

The effectiveness of such therapy becomes noticeable after about 14-20 days, and the maximum result is achieved after 2-3 months from the start of treatment. After the desired effect has been achieved, the dosage is gradually lowered, leaving only maintenance medication.

Supportive therapy can last 6-7 years. If after the termination of the course the disease resumes, then the treatment can be started anew (as a rule, the relapse occurs within 3-6 months).

Surgical treatment (removal of areas of the gland tissues) is indicated in situations where medications do not have the expected effect. Surgery - subtotal thyroidectomy is a relatively safe intervention that is performed only in the stage of remission of hyperthyroidism (in the state of euthyroidism), that is, after 2-3 months of conservative therapy. For 2 weeks before the operation, the patient is prescribed a solution of potassium iodide (5 cap / d), to reduce the blood supply of the thyroid gland.

Of the possible postoperative complications, hypothyroidism (transient or persistent) and the development of vocal paralysis can be identified. However, such consequences are extremely rare.

Alternative treatment of hyperthyroidism in children

Regardless of the prescribed treatment of hyperthyroidism, it is recommended to additionally use herbal preparations that have sedative and restorative properties. An important role is also played by the regime of the day, with alternating periods of stress and rest. The child should provide a full-fledged diet, which must satisfy the need of the child's body in protein and vitamins.

Herbal treatment involves the use of such herbal remedies:

• To stabilize the nervous system and fight against insomnia, you can use an infusion of valerian root, one third of the glass up to 3 times a day (the third time - half an hour before bedtime).
• Soothing effect possesses a motherwort infusion, which is taken at 1 tbsp. L. Three times a day.
• Calms heart activity, eliminates irritability, facilitates the process of falling asleep tea from hawthorn. You can buy in the pharmacy liquid extract (extract) from the fruits of the plant, which is taken 25 drops to 4 times a day before eating.
• To stabilize the mineral and vitamin metabolism use tea from dog rose, 100-150 ml three times a day.
• If possible, it is recommended to prepare a medicinal harvest from the root of licorice (1 part) and the root of the madder dyeing (2 parts). From this quantity of raw materials prepare a decoction, which is taken in the morning on an empty stomach in the amount of 100-200 ml, depending on the age of the child.

Alternative treatment should not be the only method: herbal preparations can be used only on the background of the main drug therapy.

[39], [40]

Homeopathy in children with hyperthyroidism

Specialists in homeopathy claim that hyperthyroidism can be cured, but only if the patient has not undergone an operation to remove the thyroid tissue.

What are the features of this treatment?

Homeopathic preparations have the ability to regulate metabolic processes, in particular, the exchange of iodine in the body. This facilitates the absorption and absorption of iodine.

With excessive thyroid function and increased production of hormones, experts advise the use of homeopathy based on iodine and iodide salts, organic iodine preparations (banyag, spongy, fucus), thyroidinum with medium (C 30) or strong (C 200) dilution at large intervals (from 1 to 3 weeks).

The purpose of prescribing homeopathy for hyperthyroidism is the natural stabilization of the thyroid function, bringing all the systems of the body into a state of natural balance, in which the protective forces themselves direct their action to restore the endocrine system.

However, one must take into account that treatment with homeopathic remedies should be performed against the background of drug therapy. Medications can be canceled only if the gland function begins to stabilize.

Prevention

Prevention of the disease consists in regular visits to the pediatric endocrinologist, especially in cases where the child has a genetic predisposition to the onset of the disease.

Positive effects on the body as a whole, and on the thyroid gland in particular, have a hardening procedure - they help the endocrine system become resistant to stressful situations.

Nutritional diet of the baby must contain a sufficient number of vitamins and trace elements. It is necessary to pay attention to the use of iodine-containing foods - the food should be balanced and full.

You can not abuse stay in the sun, but do not give up tanning at all - moderate sunny and airy baths are only welcome.

Negative impact on the thyroid gland can have radiographic examination, so resort to this method of diagnosis is recommended only as a last resort, with the urgent need.

[41], [42], [43], [44], [45], [46]

Forecast

Hyperthyroidism, found in newborns, usually passes without a trace throughout the first three months of life (only in rare cases, the disease is delayed for several years).

However, in older children, the disease is much easier than in adults - with drug correction and normalization of physical and mental loads. In the majority of patients, hyperthyroidism does not end with disability and lifelong medication.

The severe course of the disease is not observed so often and in most cases is due to a genetic predisposition. If someone in the family has had thyroid pathologies, then the endocrine health of the child should be given special attention.

Hyperthyroidism in children is relatively rare, but it is always better to visit an endocrinologist and make sure of your baby's health. In case of illness, the doctor will be able to prescribe the treatment in a timely manner, which will significantly improve the prognosis in the future.

[47], [48]