Hypothyroidism and HashimotoÃ¢ï¿½ï¿½s in children Ã¢ï¿½ï¿½ how it is diagnosed and treatment
Most thyroid disease seen in adults also occur in children. Although there are some differences in management, the principles remain the same. It is very important to explain to the child, depending on their level of understanding, where the thyroid is and what it does. A good way to describe the shape of the thyroid is to compare it to a butterfly sitting in the centre of the front of the neck over the windpipe and just above the collar bone. The outline can be seen on a child’s neck by raising the chin and tilting the head slightly back, especially if the thyroid is larger than normal. Its function, or job, can be compared to that of a furnace. If the thyroid is overactive (hyperthyroid), it can be considered as turned up too high; if underactive (hypothyroid), as turned down too low; or if the thyroid, no matter what its size, is making the right amount of thyroid hormone, then the thermostat is set just right.
Hashimoto’s Thyroiditis (Autoimmune Thyroiditis) in children
The most frequent cause of thyroid enlargement in children and adolescents is Hashimoto’s thyroiditis. This is more common in girls and in those with a family history of Hashimoto’s or other thyroid disorders. Apart from the enlarged thyroid, there may be no other changes unless hypothyroidism develops. The management of Hashimoto’s thyroiditis in children and adolescents is exactly the same as in adults. Over time, the thyroid will become smaller but this may take several years. In Hashimoto’s thyroiditis, thyroid hormone secretion may be normal at diagnosis, but monitoring is recommended in case hypothyroidism develops. Treatment with thyroid hormone, once started, is taken for life. There are special groups of children, such as those with Diabetes Mellitus type 1, Down Syndrome, or Turner Syndrome, who should be regularly checked, as they are more likely to develop Hashimoto’s thyroiditis.
What Tests are Usually Done to Make a Diagnosis in Your Child?
A simple blood test for TSH and T4 measurement can be taken to see if the thyroid gland is functioning normally. This also checks to ensure the medication dosage is the correct amount.
In children with hypothyroidism, an x-ray of the hand and wrist (knee in infants) may be taken to determine the degree of delayed bone growth. It is usually unnecessary to perform ultrasounds of the thyroid unless the enlargement is uneven, a lump or a nodule is suspected. If there is a nodule, an ultrasound will help to tell if it is fluid-filled or solid. A thyroid scan uses a very safe weak radioactive material to see if the thyroid behaves in a normal way by taking up the radioactivity evenly. A spot with no uptake of radioactivity may be described as "cold" and could be a tumour. In some cases a thyroid biopsy, using a small needle may be done. The needle is placed in the thyroid to remove some cells for examination under a microscope. Older children tolerate this procedure well without sedation. If they are scared, a hand held by a parent and some anaesthetic cream helps.
If you are unsure of going the conventional medication route for your child’s hypothyroidism or Hashimoto’s, then you need to consult Dr Alain Sanua. As a qualified doctor of naturopathy and homeopathy, Dr Alain Sanua will help you find a natural way to deal with your child’s illness. To book a consultation with Dr Alain Sanua, or to find out more about his wellness clinic, visit his website www.dralainsanua.co.za