Hypothyroidism in Children: Growth Concerns and Treatment

Q: Hypothyroidism in Children: Growth Concerns and Treatment

Hello： Estimating adult height should also take into account the heights of the parents, generally calculated as the average of the parents' heights +/- 6.5 cm. <br>If a child's height is significantly below the estimated value based on the parents' heights, it is important to co

Hypothyroidism

Hello Doctor, my son had normal results during the newborn screening at birth.
His growth curve has consistently been around the 3rd percentile, and all other growth assessments have been normal.
However, over the past two to three years, I have noticed that his height and weight have been growing slowly (born in 2016, currently 8 years old, height 115 cm, weight 19 kg), so we went to the hospital for evaluation.
An X-ray showed that his bone age is only 5 years, and blood tests indicated hypothyroidism.
The doctor advised me to focus on weight gain and to include more iodine-rich foods in his diet, and to return for another blood test in three months to check if the thyroid hormone levels have improved.
If they have not improved, we will consider medication.
I would like to ask if it is too late to evaluate this, which may have caused my son's growth delay? Will starting treatment now affect his cognitive development? Is there a risk of him developing intellectual disability? (My son has good energy levels, and his skin is not dry; the only concern seems to be that he often has trouble concentrating and is somewhat slow to respond.)

Cindy, 40~49 year old female. Ask Date: 2024/02/20

Dr. Pei Rensheng reply Pediatrics

Hello: Estimating adult height should also take into account the heights of the parents, generally calculated as the average of the parents' heights +/- 6.5 cm.
If a child's height is significantly below the estimated value based on the parents' heights, it is important to consider: 1.
Late growth spurts, and 2.
Other conditions, including normal newborn screening for congenital hypothyroidism, which is less likely to be congenital; if it is acquired hypothyroidism, the standard treatment is to provide thyroid hormone, not iodine.
Please consult a pediatric endocrinologist for further confirmation.
Wishing you health and safety! Sincerely, Ren Sheng.

Reply Date: 2024/02/20

More Info

Hypothyroidism in children can significantly impact growth and development, and it is understandable that you are concerned about your son's growth trajectory and overall health. Let's break down your questions and provide a comprehensive overview of hypothyroidism in children, its implications, and treatment options.

Understanding Hypothyroidism
Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones, which are crucial for regulating metabolism, growth, and development. In children, adequate levels of thyroid hormones are essential not only for physical growth but also for cognitive development. The condition can be congenital (present at birth) or acquired later in life. In your son's case, it seems that the hypothyroidism was identified later, which can sometimes lead to concerns about growth and cognitive function.

Growth Concerns
Your son's growth measurements indicate that he is in the 3rd percentile for height and weight, which is concerning, especially given that his bone age is significantly delayed (5 years old when he is actually 8). This discrepancy suggests that his growth plates are not maturing at the expected rate, which can be a consequence of untreated hypothyroidism.

Timing of Evaluation and Treatment
It is important to note that while early detection and treatment of hypothyroidism are ideal, it is never too late to start treatment. The fact that your son has been evaluated now means that you can take steps to address his condition. Delayed treatment can lead to more pronounced growth issues and potential cognitive delays, but starting treatment now can help mitigate these risks.

Impact on Intelligence
Untreated hypothyroidism in children can lead to developmental delays, including cognitive impairments. However, the extent of these effects often depends on the severity and duration of the hormone deficiency. Since your son is active and does not exhibit other symptoms commonly associated with severe hypothyroidism (like dry skin or lethargy), it is possible that he may not experience significant cognitive impairment. Nevertheless, attention difficulties can be a sign of hypothyroidism, and addressing the hormone deficiency may improve these symptoms.

Treatment Options
The initial approach of dietary adjustments to increase iodine intake is a good start, as iodine is essential for thyroid hormone production. However, if blood tests after three months show that thyroid hormone levels have not normalized, your doctor may recommend starting thyroid hormone replacement therapy, typically with levothyroxine. This medication is a synthetic form of the thyroid hormone thyroxine (T4) and is effective in restoring normal hormone levels.

Monitoring and Follow-Up
Regular follow-up appointments will be crucial to monitor your son's growth, development, and thyroid hormone levels. Adjustments to medication dosages may be necessary as he grows. Additionally, monitoring his cognitive development and behavior will help assess the impact of treatment on his overall well-being.

Conclusion
In summary, while it is concerning that your son has been diagnosed with hypothyroidism and has experienced growth delays, starting treatment now can significantly improve his growth potential and cognitive development. It is essential to work closely with your healthcare provider to monitor his progress and make necessary adjustments to his treatment plan. Early intervention is key, and with appropriate management, many children with hypothyroidism can achieve normal growth and development.

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