Hyperthyroidism in Children
Hyperthyroidism in children is a condition in which an overactive thyroid gland is producing an excessive amount of thyroid hormones that circulate in the blood (“Hyper” means “over” in Greek.) Thyrotoxicosis is a toxic condition that is caused by an excess of thyroid hormones from any cause. Thyrotoxicosis can be caused by an excessive intake of thyroid hormone (for example so called “hamburger” thyrotoxicosis) or by overproduction of thyroid hormones by the thyroid gland.
The thyroid gland extracts iodine from the blood (which comes mostly from a diet of foods such as seafood and salt for example) and uses it to produce thyroid hormones (more specifically triiodothyronine (T3) and Thyroxine (T4). The Thyroid Stimulating Hormone (TSH), which is usually used as a marker to indicate whether or not there is a thyroid dysfunction, is a pituitary gland hormone secreted to regulate these hormones. In 80% of the cases the cause for hyperthyroidism is an autoimmune disorder called Graves’ Disease, but it could be also a goiter or other thyroid abnormality.
Symptoms of Hyperthyroidism in Children
The symptoms of Hyperthyroidism in children are usually similar to those in adults: heart palpitations, restlessness, insomnia, emotional lability, nervousness, heat intolerance, decreased concentration, increased appetite and weight loss, to name just a few. These symptoms however, mimic the symptoms of some other disorders, mainly psychological, and thus, the children can often be misdiagnosed. An abundant number of purely physical disorders or mental conditions can duplicate or imitate some of the symptoms of hyperthyroidism in children: sleep apnea, lead contamination, pinworms, excessive intake of caffeine or substance abuse, Fragile X syndrome, overly sweet foods with high quantities of glucose, excessive consumption of foods with artificial coloring, abnormal level of insulin in the blood, and fetal alcohol syndrome, or even celiac disease, to name a few. On the psychological scale, hyperthyroidism can often be mistaken with mood disorders, generalized anxiety disorder, bipolar disorder, some learning disorders, oppositional defiant disorder (ODD), conduct disorder (CD), adjustment disorder, pervasive developmental disorders (PDD), or even normal developmental deviations. Children, often labeled as hyperactive or diagnosed with ADHD may, in fact, have hyperthyroidism. Hyperthyroidism in children may present itself with many and different faces.
Unfortunately, thyroid blood test results are not so reliable to diagnose this complicated disorder. The normal ranges of the most used thyroid indicators are as follows: Thyroid Stimulating Hormone (TSH) 0.3–3.0 μU/ml; Free thyroxine (FT4) 7–18 ng/l = 0.7–1.8 ng/dl; Serum thyroxine (T4) 46–120 μg/l = 4.6–12.0 μg/dl; Free triiodothyronine (FT3) 230–619 pg/d; Serum triiodothyronine (T3) 0.8–1.8 μg/l = 80–180 ng/dl (per American Thyroid Association guidelines, but may vary by different laboratories).
Thyroid test abnormalities are the first indicator that something might be wrong. Once diagnosed, there are 3 options for treatment that are widely recommended by physicians and endocrinologists: Radioactive Iodine treatment (RAI), thyroidectomy and medication (propylthiouracil or methimazole). While the first two are very invasive methods that have life time consequences for the child, the medication method is considered the most appropriate by many physicians. The remission rates vary from 20 to about 50%, depending on many other factors and how severe was the disease when initially diagnosed.
Regardless, I would definitely suggest trying medication first, together with diet correction, vitamins, minerals and life style changes in order to control hyperthyroidism in children and adolescents. For example, the “Elimination diet” is found by some scientists to reduce over-activity symptoms in children drastically. The foods, included in the elimination diet, are mostly fruits, vegetables, some light meat, juices and water, which is a relatively restrictive diet but not impossible to implement. Later on, new foods may be added one by one every week and children should be monitored for see how they react. Many of the symptoms of hyperthyroidism in children with this diet may vanish. It is also preferable to use organic vegetables and fruits in this diet as they contain more nutrients compared to genetically modified foods. Especially useful are goitrogenic foods and vegetables like broccoli, cauliflower and all green leafy vegetables. You may check the diet suggestions for hyperthyroidism here: Diet for Hyperthyroidism. Also consider the restriction of iodine- rich foods like sea foods and nuts, especially walnuts. Avoiding aspartame (in diet sodas, chewing gums etc.) may dramatically improve nervousness and agitation in children.
You may be surprised how introducing small changes in diet and life style may lead to hyperthyroidism symptoms improvement.
Consult a physician or dietitian before implementing this restrictive diet as they may recommend adding additional vitamins and supplements.
There are also herbal preparations with Lemon Balm and Chamomile which are safe for children and may help different symptoms like palpitations, anxiety and insomnia. Meditation and yoga are some other alternative methods that can significantly and positively influence hyperthyroidism in children, even though it might be challenging for parents to introduce this methods into children’s daily routine, depending on the age of the child.
It is also a fact, that during teenage years the children go through many hormonal changes which may affect their thyroid function. I would rather consider hyperthyroidism in children as a temporary condition that will pass, as any other ailments, if, of course, is properly addressed and treated. “Killing” the thyroid with RAI and thyroidectomy is an aggressive procedure that leads to permanent, life time hypothyroidism with all side effects and consequences.
For more information, check my book on “Children with Graves’ Disease” which may help you make the right decision for your child.
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