Thyroid problems in children: the signs we watch for and what the tests mean

The thyroid is a small gland in the neck that sets the pace for growth and metabolism. In children the most common problem is an underactive gland, and the most important thing to know is that it is easy to test for and, once found, easy to treat.

At birth

Congenital hypothyroidism affects about one in 2,000 to 4,000 babies and, untreated, harms brain development. That is why it is on the Georgia newborn screen, drawn from the heel between 24 and 48 hours of age. If a result comes back abnormal we call the family the same day, repeat the test, and start thyroid hormone within days if it is confirmed. Children treated early grow and learn normally.

Later in childhood

Acquired hypothyroidism usually comes from Hashimoto’s thyroiditis, an autoimmune condition that runs in families and is more common in girls, in children with type 1 diabetes and in children with Down syndrome. The signs are slow: a child who has dropped across growth percentiles, tires easily, is constipated, feels cold, has dry skin, or whose puberty is late. An overactive thyroid, most often Graves’ disease, shows the opposite: weight loss with a good appetite, a fast heartbeat, tremor, trouble sleeping, and sometimes a visible swelling at the front of the neck.

What we check

Growth is the first test, which is why we plot height and weight at every visit; a falling height percentile is often the earliest sign. When the picture fits, one blood draw measures thyroid-stimulating hormone (TSH) and free thyroxine (T4), and antibodies if we suspect an autoimmune cause. A lump in the neck gets an ultrasound. Most thyroid nodules in children are benign, but a higher share are cancerous than in adults, so every nodule is evaluated properly and never watched casually.

Treatment

• Underactive thyroid: a daily tablet of levothyroxine, with the dose adjusted to blood levels every few months as the child grows
• Overactive thyroid: an antithyroid medicine, managed with a pediatric endocrinologist; radioactive iodine or surgery are options when medicine is not enough
• Nodules: ultrasound, sometimes a needle biopsy, and referral to a pediatric endocrinologist or surgeon when needed

How we work with the specialist

Children with thyroid disease are followed jointly: the pediatric endocrinologist at Children’s Healthcare of Atlanta sets the plan, and we do the between-visit labs, growth checks, refills and school forms, and make sure results reach both offices. Families should not have to drive to the specialist for a routine blood draw.

If your child’s growth has slowed, or you have noticed the signs above, ask us at the next visit or call. The test is quick and the treatment works.