Hyperthyroidism in children

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

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Causes hyperthyroidism in a child

Today, several possible factors of excessive thyroid function are identified:

• hyperactivity of follicular cellular structures of glandular tissues, resulting in the production of large amounts of triiodothyronine and thyroxine;
• 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 dosage calculation.

The immediate causes of the disease may be:

• an autoimmune disease of the thyroid gland that is accompanied by excessive production of hormones;
• infectious or viral pathologies of the thyroid gland with destruction of gland cells;
• nodular formations in the gland;
• tumor processes in the pituitary gland;
• tumor processes in the thyroid gland (for example, adenoma);
• some diseases of the appendages;
• genetic predisposition to thyroid problems.

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Pathogenesis

Stimulation of the thyroid gland to produce excess hormones often occurs at the local level: glandular tissue grows due to internal pathologies, such as a tumor process.

Systemic (central) stimulation is also allowed, in which the excessive function of the thyroid gland is explained by the effect of hormones of the pituitary gland - an endocrine gland, the so-called appendage of the brain, which controls the function of the entire endocrine system. The pituitary gland can mistakenly send an excessive number of signals to the normally functioning thyroid gland, and it, following these messages, begins to produce hormones in an accelerated mode.

In some cases, the thyroid receptor mechanism is not stimulated by the hormonal pituitary system. The culprit is 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 manifests itself as thyrotoxicosis or diffuse toxic goiter.

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Symptoms hyperthyroidism in a child

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

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

The first signs in childhood are emotional instability against 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 notice trembling in the fingers. Appetite increases noticeably, but there is no increase in body weight (sometimes even the opposite - the baby loses weight). The thyroid gland increases, which is noticeable not only by touch, but also visually. When listening, you can hear noises.

Many children develop exophthalmos. Sometimes specific symptoms are also found:

• Graefe's symptom - when the upper eyelid lags slightly when looking downwards;
• Moebius symptom - convergence disorder;
• Stellwag's symptom - rare blinking and retraction of the upper eyelid.

The skin is usually moist (due to increased sweating), reddened. Muscle weakness may be observed, up to a change in gait (clumsiness, stumbling). The heartbeat increases, shortness of breath appears.

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

A child with hyperthyroidism is usually tall. There are no differences in sexual development from peers.

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Complications and consequences

Hyperthyroidism, which began to develop in the neonatal period, is usually temporary and resolves within three months (less often - several years). A later onset of the disease has a less positive prognosis.

One of the most dangerous complications of hyperthyroidism in children can be a thyrotoxic crisis, or hyperthyroid coma. This condition can develop with moderate to severe disease. Any operations, improper treatment of the thyroid gland, systemic diseases, infectious pathologies contribute to the occurrence of a crisis.

Signs of a thyrotoxic crisis include:

• sudden increase in temperature;
• general excitement, quickly followed by immobility;
• severe vomiting, diarrhea, general loss of fluid;
• a sharp drop in blood pressure.

If the child is not given help in time, loss of consciousness, cardiac dysfunction and even death are possible.

Hyperthyroidism can also lead to a disruption of sexual function, which in the future can provoke problems with potency.

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Diagnostics hyperthyroidism in a child

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

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

If hyperthyroidism is suspected, confirming the disease is usually not difficult. The characteristic criteria are the patient's appearance, complaints, and test results. Functional hyperactivity of the gland is easily confirmed by laboratory research methods. First, the doctor must determine the level of thyroid hormones.

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

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Differential diagnosis

Differential diagnostics are carried out:

• with lymphocytic thyroiditis;
• with pheochromocytoma.

Treatment hyperthyroidism in a child

There is no single best way to treat hyperthyroidism in children: the therapeutic regimen is always selected individually. Some doctors prefer surgical methods (subtotal thyroidectomy), while others start with drug therapy.

Endocrinologists and radiotherapists do not recommend prescribing radioactive iodine in childhood - this method of influencing the thyroid gland is now used mainly for patients over 50 years of age. Exceptions may be cases in which medications do not bring results, and surgical intervention is contraindicated.

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

The initial dose of Propylthiouracil may be 100 to 150 mg three times a day, and Mercazolil is prescribed in the amount of 10-15 mg three times a day. Subsequently, the dosage can be increased or decreased, depending on the indications. The younger the child, the lower 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 reduced, leaving only maintenance medication.

Maintenance therapy can last for 6-7 years. If the disease recurs after the end of the course, the treatment can be started again (as a rule, a relapse occurs within 3-6 months).

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

Possible postoperative complications include hypothyroidism (transient or permanent) and the development of vocal paralysis. However, such consequences are extremely rare.

Folk treatment of hyperthyroidism in children

Regardless of the prescribed treatment regimen for hyperthyroidism, it is recommended to additionally use herbal preparations with sedative and tonic properties. The daily routine, with alternating periods of stress and rest, also plays an important role. The child should be provided with adequate nutrition, which should satisfy the child's body's need for protein and vitamins.

Herbal treatment involves the use of the following herbal remedies:

• To stabilize the nervous system and combat insomnia, you can use an infusion of valerian root, a third of a glass up to 3 times a day (the third time - half an hour before bed).
• Motherwort infusion has a calming effect; take 1 tablespoon three times a day.
• Hawthorn tea calms the heart, eliminates irritability, and facilitates the process of falling asleep. You can buy a liquid extract from the fruits of the plant at the pharmacy, which is taken 25 drops up to 4 times a day before meals.
• To stabilize the mineral and vitamin exchange process, use rosehip tea, 100-150 ml three times a day.
• If possible, it is recommended to prepare a medicinal mixture of licorice root (1 part) and madder root (2 parts). From this amount of raw materials, a decoction is prepared, which is taken in the morning on an empty stomach in the amount of 100-200 ml, depending on the age of the child.

Traditional medicine should not be the only method: herbal preparations can only be used in conjunction with basic drug therapy.

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Homeopathy for hyperthyroidism in children

Homeopathic experts claim that hyperthyroidism can be cured, but only if the patient has not undergone surgery to remove thyroid tissue.

What might be the features of this treatment?

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

In case of excessive thyroid function and increased hormone production, experts recommend using homeopathic remedies based on iodine and iodine salts, organic iodine-containing preparations (badyagi, spongia, fucus), thyroidinum with medium (C 30) or strong (C 200) dilution with long intervals (from 1 to 3 weeks).

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

However, it should be taken into account that homeopathic treatment should be carried out against the background of drug therapy. Medicines can be canceled only when the function of the gland begins to stabilize.

Prevention

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

Hardening procedures have a positive effect on the body as a whole, and on the thyroid gland in particular – they help the endocrine system become resistant to stressful situations.

The baby's diet must necessarily contain a sufficient amount of vitamins and microelements. It is necessary to pay attention to the consumption of iodine-containing products - the diet must be balanced and complete.

You shouldn't overuse the sun, but you shouldn't give up tanning altogether - moderate sunbathing and air bathing are only welcome.

X-ray examination can have a negative impact on the thyroid gland, so it is recommended to resort to this diagnostic method only as a last resort, in case of urgent need.

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Forecast

Hyperthyroidism detected in newborns usually goes away without a trace during the first three months of life (only in rare cases does the disease last for several years).

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

Severe course of the disease is not observed so often and in most cases is caused by genetic predisposition. If someone in the family suffered from thyroid pathologies, then the child's endocrine health should be given special attention.

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

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