Hypothyroidism in Children: Growth Concerns and Treatment

Q: Hypothyroidism in Children: Growth Concerns and Treatment

Hello： 1. <br>An 8-year-old was diagnosed with hypothyroidism; newborn screening was normal. <br>The most common cause is autoimmune disease leading to acquired hypothyroidism. <br>2. <br>The standard treatment for hypothyroidism is thyroid hormone replacement, not iodine supplem

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 low thyroid hormone levels.
The doctor advised us to focus on weight gain and to include more iodine-rich foods in his diet, and to return for a blood test in three months to reassess his thyroid hormone levels.
If they haven't improved, we will consider medication.
I would like to ask if it is too late to evaluate this, which has led to my son's growth delay? Will starting treatment now affect his intelligence? Is there a risk of developing intellectual disability? (My son has good energy levels, his skin is not dry, and the only concern seems to be that he often has difficulty concentrating and is somewhat slow to respond.)

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

Dr. Pei Rensheng reply Pediatrics

Hello: 1.
An 8-year-old was diagnosed with hypothyroidism; newborn screening was normal.
The most common cause is autoimmune disease leading to acquired hypothyroidism.
2.
The standard treatment for hypothyroidism is thyroid hormone replacement, not iodine supplementation.
3.
A child's growth is significantly influenced by their parents, so parental height and weight should also be considered.
4.
It is recommended to consult a pediatric endocrinologist to confirm the diagnosis and determine whether iodine supplementation is sufficient or if thyroid hormone replacement is necessary.
Wishing you health and peace, Ren Sheng.

Reply Date: 2024/02/20

More Info

Hypothyroidism in children is a significant concern, especially when it comes to growth and development. Your son’s situation, where he has been consistently in the 3rd percentile for growth and has a significantly delayed bone age, raises important questions about his thyroid function and overall health.

1. Understanding Hypothyroidism: Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones, which are crucial for growth, metabolism, and brain development. In children, untreated hypothyroidism can lead to growth delays and cognitive impairments. The symptoms can be subtle, and in some cases, children may not exhibit the classic signs of hypothyroidism, such as dry skin or lethargy, which can make diagnosis challenging.

2. Impact on Growth: Given that your son’s thyroid hormone levels are low, this could indeed be a contributing factor to his slow growth. Thyroid hormones play a vital role in skeletal development and growth regulation. If hypothyroidism is diagnosed and treated early, children can often catch up in growth. However, if treatment is delayed, there may be lasting effects on growth and development, including the potential for intellectual disabilities, commonly referred to as "cretinism" or "dwarfism" in severe cases of untreated hypothyroidism.

3. Timing of Diagnosis and Treatment: It’s understandable to wonder if you sought help too late. While early diagnosis is ideal, it’s never too late to start treatment. The key is to initiate therapy as soon as hypothyroidism is confirmed. Your doctor’s plan to monitor your son’s thyroid levels after dietary adjustments is a reasonable approach. If thyroid hormone levels do not improve, medication such as levothyroxine will likely be necessary. This medication is a synthetic form of the thyroid hormone thyroxine (T4) and is typically well-tolerated.

4. Cognitive Development: Regarding your concerns about cognitive function, it is important to note that untreated hypothyroidism can affect brain development, particularly in younger children. However, if treatment is initiated promptly, many children can achieve normal cognitive function. Your son’s activity level and general health are positive signs, but attention difficulties can sometimes be associated with hypothyroidism. Once thyroid levels are normalized, you may find improvements in his concentration and overall cognitive performance.

5. Nutritional Considerations: While increasing iodine intake through diet can support thyroid function, it is essential to follow your doctor’s recommendations closely. Foods rich in iodine include fish, dairy products, and iodized salt. However, dietary changes alone may not be sufficient to correct hypothyroidism if hormone levels are significantly low.

6. Follow-Up and Monitoring: Regular follow-up with your healthcare provider is crucial. Monitoring thyroid hormone levels will help assess the effectiveness of treatment and make necessary adjustments. Additionally, tracking growth patterns and developmental milestones will provide insight into your son’s progress.

In summary, while your son’s late diagnosis of hypothyroidism may raise concerns, early intervention can significantly improve outcomes. It is essential to work closely with your healthcare provider to ensure that his thyroid levels are adequately managed and to monitor his growth and development closely. With appropriate treatment, many children with hypothyroidism can lead healthy, normal lives.

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