What is hyperthyroidism?
Hyperthyroidism (overactive thyroid) is a condition in which your child’s thyroid gland makes too much thyroid hormone. The over-secretion of thyroid hormone leads to over-activity of your child’s metabolism and can cause sudden weight loss, a rapid or irregular heartbeat, sweating, nervousness and irritability.
Treatment for hyperthyroidism depends on the severity of your child’s condition. Many children are helped with anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. In some cases, surgery to remove part or all of your child’s thyroid gland is necessary.
There are several types of hyperthyroidism, including:
Graves’ disease
Graves’ disease occurs when your child’s immune system develops antibodies that attach to the thyroid cells, causing them to produce more thyroid hormone. The antibodies (thyroid-stimulating hormone-receptor antibodies, also known as TRAb) bind to the thyroid-stimulating hormone (TSH) receptor and may cause stimulation or, less commonly, blocking of thyroid hormone production.
Graves’ disease is much less common than autoimmune hypothyroidism (also known as Hashimoto’s thyroiditis). It is more common in girls than in boys, and more common in adolescents. Graves' disease was named after an Irish doctor, Sir Robert Graves, who first described the condition in the early 19th century.
Autoimmune diseases, such as Graves’ disease, occur more frequently within the family of an affected person, but it is difficult to predict if an individual family member will develop an autoimmune disease and what specific disease he or she may develop.
Hyperfunctioning thyroid nodules
Hyperfunctioning thyroid nodules — also known as Plummer’s disease, toxic adenoma and toxic multi-nodular goiter — are another form of hyperthyroidism. They occur when one or more benign growths in your child’s thyroid produce too much thyroxineb (T-4), a hormone that contains iodine. Not all of these benign growths, called adenomas, produce excess T-4, but they can enlarge the thyroid and form lumps in the butterfly-shaped gland at the base of your child’s neck.
Thyroiditis
Another form of hyperthyroidism is thyroiditis, a condition that occurs when your child’s thyroid gland becomes inflamed and causes excess thyroid hormone to leak into the bloodstream. While the source of the inflammation is often unknown, one rare type of thyroiditis, called subacture thyroiditis, can cause pain in your child’s thyroid gland. Most types of thyroiditis are painless.
Thyroid storm
There is a very rare, but severe and life-threatening form of hyperthyroidism called thyroid storm. Children with this condition have extremely high levels of thyroid hormone that can cause high fever, dehydration, diarrhea, rapid and irregular heart rate, shock and even death, if not treated. Patients with thyroid storm are cared for in the intensive care unit with intravenous fluids, steroids, cold-iodine, beta-blockers and/or anti-thyroid medications.
Hyperthyroidism
Diagnostic evaluation for hyperthyroidism begins with a thorough medical history and physical examination of your child. At The Children’s Hospital of Philadelphia, clinical experts use a variety of diagnostic tests to diagnose hyperthyroidism, including:
Anti-thyroid medication
Most children and adolescents with hyperthyroidism will be started on anti-thyroid medication (Methimazole/Tapazole/MMI) at the time of diagnosis. For patients with severe symptoms, including elevated heart rate, palpitations and anxiousness, a medicine called a "beta-blocker" will be added to help decrease symptoms while the anti-thyroid medications take effect.
Hyperthyroidism is harder to control in patients who are very young and have very high thyroid hormone levels at the time of their diagnosis. It is less likely for these patients to achieve remission of their disease, and more aggressive treatments will be sought with the help of experts in the Pediatric Thyroid Center.
Children with hyperthyroidism who may need additional treatment include:
Radioactive iodine ablation
Radioactive iodine (RAI) ablation is one of two options to permanently treat hyperthyroidism. Known as “definitive therapy,” RAI ablation medically destroys your child’s thyroid gland.
The benefits of RAI ablation include:
RAI ablation is not appropriate for all patients. Risks and concerns include:
Thyroidectomy
Thyroidectomy is the second way to permanently treat hyperthyroidism. Known as “definitive therapy,” thyroidectomy surgically removes your child’s thyroid gland.
The benefits of thyroidectomy include:
Thyroidectomy also has risks and concerns including:
Information courtesy : CHOP
Hyperthyroidism (overactive thyroid) is a condition in which your child’s thyroid gland makes too much thyroid hormone. The over-secretion of thyroid hormone leads to over-activity of your child’s metabolism and can cause sudden weight loss, a rapid or irregular heartbeat, sweating, nervousness and irritability.
Treatment for hyperthyroidism depends on the severity of your child’s condition. Many children are helped with anti-thyroid medications and radioactive iodine to slow the production of thyroid hormones. In some cases, surgery to remove part or all of your child’s thyroid gland is necessary.
There are several types of hyperthyroidism, including:
Graves’ disease
Graves’ disease occurs when your child’s immune system develops antibodies that attach to the thyroid cells, causing them to produce more thyroid hormone. The antibodies (thyroid-stimulating hormone-receptor antibodies, also known as TRAb) bind to the thyroid-stimulating hormone (TSH) receptor and may cause stimulation or, less commonly, blocking of thyroid hormone production.
Graves’ disease is much less common than autoimmune hypothyroidism (also known as Hashimoto’s thyroiditis). It is more common in girls than in boys, and more common in adolescents. Graves' disease was named after an Irish doctor, Sir Robert Graves, who first described the condition in the early 19th century.
Autoimmune diseases, such as Graves’ disease, occur more frequently within the family of an affected person, but it is difficult to predict if an individual family member will develop an autoimmune disease and what specific disease he or she may develop.
Hyperfunctioning thyroid nodules
Hyperfunctioning thyroid nodules — also known as Plummer’s disease, toxic adenoma and toxic multi-nodular goiter — are another form of hyperthyroidism. They occur when one or more benign growths in your child’s thyroid produce too much thyroxineb (T-4), a hormone that contains iodine. Not all of these benign growths, called adenomas, produce excess T-4, but they can enlarge the thyroid and form lumps in the butterfly-shaped gland at the base of your child’s neck.
Thyroiditis
Another form of hyperthyroidism is thyroiditis, a condition that occurs when your child’s thyroid gland becomes inflamed and causes excess thyroid hormone to leak into the bloodstream. While the source of the inflammation is often unknown, one rare type of thyroiditis, called subacture thyroiditis, can cause pain in your child’s thyroid gland. Most types of thyroiditis are painless.
Thyroid storm
There is a very rare, but severe and life-threatening form of hyperthyroidism called thyroid storm. Children with this condition have extremely high levels of thyroid hormone that can cause high fever, dehydration, diarrhea, rapid and irregular heart rate, shock and even death, if not treated. Patients with thyroid storm are cared for in the intensive care unit with intravenous fluids, steroids, cold-iodine, beta-blockers and/or anti-thyroid medications.
Hyperthyroidism
Diagnostic evaluation for hyperthyroidism begins with a thorough medical history and physical examination of your child. At The Children’s Hospital of Philadelphia, clinical experts use a variety of diagnostic tests to diagnose hyperthyroidism, including:
- Thyroid function screening, a blood test that measures thyroid hormone (thyroxine or T4) and serum TSH (thyroid-stimulating hormone) levels. Hyperthyroidism is diagnosed when the thyroid-stimulating hormone (TSH) level is below normal and the triiodothyronine (T3) and thyroxine (T4) levels are above normal. In "early" Graves’ disease, the T3 may be elevated before the T4. The presence of thyroid receptor antibodies (TRAb, TSI and/or TBII) help to confirm the diagnosis.
- Thyroid ultrasound, which uses ultrasonic waves to image your child’s thyroid and nearby organs and muscles. Classic findings of hyperthyroidism include an enlarged thyroid gland with increased blood flow throughout the gland.
- Nuclear medicine uptake and scan, which helps determine how well your child’s thyroid tissue absorbs iodine, a key ingredient in making thyroid hormone. For the test, your child is given a very small amount of radioactive iodine — usually I-123 — then we measure how much iodine is absorbed (uptake) and the pattern of distribution of the radioiodine in the thyroid tissue (scan). Classic findings of hyperthyroidism include increased absorption of the radioiodine (greater than 30 percent of thyroid hormone production at 24 hours) that is uniformly distributed throughout the thyroid tissue.
- Fine-needle aspiration biopsy, which uses a thin, hollow needle to take a small sample of any lumps or masses under the skin. This test is usually only done when thyroid nodules are found during a thyroid ultrasound. The biopsy sample is then tested in a laboratory.
- Depending on the cause of your child’s hyperthyroidism, treatment may include:
- Anti-thyroid medication
- Radioactive iodine ablation
- Total thyroidectomy (surgical removal of the thyroid)
Anti-thyroid medication
Most children and adolescents with hyperthyroidism will be started on anti-thyroid medication (Methimazole/Tapazole/MMI) at the time of diagnosis. For patients with severe symptoms, including elevated heart rate, palpitations and anxiousness, a medicine called a "beta-blocker" will be added to help decrease symptoms while the anti-thyroid medications take effect.
- Your child will have a scar
- There is a risk of surgical complications including hypoparathyroidism (damage to the parathyroid glands that control calcium) and recurrent laryngeal nerve damage (nerves that control the voice and help protect the airway so food, liquid or other items do not enter the lungs.
Hyperthyroidism is harder to control in patients who are very young and have very high thyroid hormone levels at the time of their diagnosis. It is less likely for these patients to achieve remission of their disease, and more aggressive treatments will be sought with the help of experts in the Pediatric Thyroid Center.
Children with hyperthyroidism who may need additional treatment include:
Radioactive iodine ablation
Radioactive iodine (RAI) ablation is one of two options to permanently treat hyperthyroidism. Known as “definitive therapy,” RAI ablation medically destroys your child’s thyroid gland.
The benefits of RAI ablation include:
RAI ablation is not appropriate for all patients. Risks and concerns include:
Thyroidectomy
Thyroidectomy is the second way to permanently treat hyperthyroidism. Known as “definitive therapy,” thyroidectomy surgically removes your child’s thyroid gland.
The benefits of thyroidectomy include:
Thyroidectomy also has risks and concerns including:
- Those who do not tolerate the anti-thyroid medication
- Those with disease that is difficult to control with the usual medical therapy
- Those who have not achieved remission despite prolonged medical therapy
- It is an oral medication.
- It avoids surgery, so there is no risk of anesthesia and no scar for your child.
- It takes longer for hyperthyroidism to resolve — usually two to three months.
- It is usually not offered to patients younger than 5 to 10 years of age.
- It may worsen eye disease associated with Graves’ disease.
- It is not as effective for large thyroid glands, which may need more than one dose of the medication.
- It is generally not recommended for children with both Graves’ disease and thyroid nodules.
- It offers a quick resolution of hyperthyroidism. There is no risk of needing a second procedure.
- There is no risk of eye disease related to hyperthyroidism worsening.
- It is the preferred treatment for children with both Graves’ disease and thyroid nodules.
- Follow-up care for your child with hyperthyroidism will depend on the type of disorder your child has and the treatment your child received.
If your child is on anti-thyroid medication, she will need ongoing follow-up care to ensure her medication dosage is appropriate as she grows.
If your child received definitive therapy of RAI ablation or thyroidectomy, he will need to take thyroid hormone replacement for the rest of his life. Thyroid hormone replacement is a once-a-day medication that requires less frequent dose adjustments and subsequently less frequent laboratory tests and doctor visits when compared to the treatment of Graves’ disease.
Information courtesy : CHOP
Hipotiroidismo en Niños
Su hijo ha sido diagnosticado con hipotiroidismo:
Esto ocurre cuando la glándula tiroides, una de las glándulas endocrinas del cuerpo, no produce suficiente hormona tiroidea. La hormona tiroidea le dice al cuerpo de su hijo cuánto aire debe respirar, cómo usar la comida, controla la temperatura del cuerpo, controla el latido cardíaco, el crecimiento del cuerpo y el desarrollo del cerebro, además de otras funciones.
Este folleto responderá a algunas de las preguntas que usted puede tener sobre esta condición y su tratamiento.
Glosario de Términos
Glándula –
Un grupo especial de células del cuerpo que libera una hormona.
Hormona –
Un mensajero químico liberado de una glándula en el torrente sanguíneo donde puede llevar su mensaje a otras células del cuerpo.
Eutiroideo –
“Eu” significa “normal”. “Eutiroideo” significa que la glándula tiroidea está funcionando de forma normal.
Hipotiroideo –
“Hipo” significa “demasiado poco o no suficiente”. “Hipotiroideo” significa que la glándula tiroides no está produciendo suficiente hormona tiroidea.
Hipertiroideo –
“Hiper” significa “demasiado.” “Hipertiroideo” significa que la glándula tiroides está produciendo más hormona tiroidea de la que el cuerpo necesita.
La Glándula Tiroidea-
La tiroides es una glándula con forma de mariposa que se encuentra en el centro del cuello. Una tiroides saludable libera hormonas, llamadas triyodotironinas (T3) y tiroxina (T4). Cuando la glándula tiroides recibe un mensaje del cerebro indicando que el cuerpo necesita estas dos hormonas, las envía al torrente sanguíneo. La sangre entonces lleva hormona tiroidea a todas las partes del cuerpo.
Los síntomas que pueden producirse cuando disminuye la function de la glándula tiroides o cuando deja de producir suficiente hormona tiroidea incluyen:
El hipotiroidismo
Tratamiento El hipotiroidismo se trata con una pastilla con hormonas. Las pastilla de hormona tiroidea que los doctores administran con frecuencia se llama Synthroid o Levothyroxine Sodium.
Es importante que se tome la pastilla a la misma hora todos los días como parte de su rutina cotidiana, de forma que que no olvide tomársela. Cada persona o familia debería encontrar la rutina adecuada que funcione en su caso.
Tenga cuidado y no le dé esta pastilla al mismo tiempo que el calcio o el hierro. Un niño que aún esté creciendo necesitará dosis distintas de hormona tiroidea a medida que se haga mayor.
Es posible que el doctor ordene que tenga una prueba de sangre antes o después de la citas clínicas para asegurar que la dosis sea la correcta. El doctor puede realizar cambios en la dosis de la pastilla basándose en los resultados de laboratorio de su hijo.
Los síntomas del hipotiroidismo desaparecerán con el tratamiento. Aún así es muy importante que siga tomando las pastillas para la tiroides.
Volverá a tener síntomas si deja de tomar las pastillas.
Síntomas de demasiada hormona tiroidea:
Visitas a la clínica
El doctor o la enfermera revisarán la función de la tiroides de varias maneras durante las citas.
Palpación –
el doctor le palpará la tiroides para ver si ha cambiado de tamaño o si un lado es más grande que el otro.
Reflejos –
El doctor le dará golpecitos en las rodillas, los tobillos, y los codos con un martillo de goma para ver si se producen contraccicones/sacudidas. Si el nivel de hormona tiroidea está bajo (hipo), es posible que los reflejos sean lentos. Si el nivel de hormona tiroidea está alto (hiper), los reflejos pueden ser rápidos.
Ritmo cardíaco –
El ritmo cardíaco puede ser más lento con el hipotiroidismo. Es posible que el ritmo cardíaco sea más rápido con el hipertiroidismo.
Presión arterial –
La presión arterial puede estar baja con el hipotiroidismo. La presión arterial puede estar alta con el hipertiroidismo.
Piel y cabello –
Es posible que tenga la piel y el cabello resecos y ásperos con el hipotiroidismo. Con el hipertiroidismo, la piel y el cabello pueden estar húmedos y grasos.
Estatura y peso –
Es posible que su hijo no crezca a un ritmo apropiado si tiene hipotiroidismo. Si tiene hipertiroidismo, es posible que crezca a un ritmo apropiado y también puede perder peso. Pesaremos y mediremos a su hijo durante las visitas clínicas para ver si su cuerpo está creciendo como debe.
Su hijo ha sido diagnosticado con hipotiroidismo:
Esto ocurre cuando la glándula tiroides, una de las glándulas endocrinas del cuerpo, no produce suficiente hormona tiroidea. La hormona tiroidea le dice al cuerpo de su hijo cuánto aire debe respirar, cómo usar la comida, controla la temperatura del cuerpo, controla el latido cardíaco, el crecimiento del cuerpo y el desarrollo del cerebro, además de otras funciones.
Este folleto responderá a algunas de las preguntas que usted puede tener sobre esta condición y su tratamiento.
Glosario de Términos
Glándula –
Un grupo especial de células del cuerpo que libera una hormona.
Hormona –
Un mensajero químico liberado de una glándula en el torrente sanguíneo donde puede llevar su mensaje a otras células del cuerpo.
Eutiroideo –
“Eu” significa “normal”. “Eutiroideo” significa que la glándula tiroidea está funcionando de forma normal.
Hipotiroideo –
“Hipo” significa “demasiado poco o no suficiente”. “Hipotiroideo” significa que la glándula tiroides no está produciendo suficiente hormona tiroidea.
Hipertiroideo –
“Hiper” significa “demasiado.” “Hipertiroideo” significa que la glándula tiroides está produciendo más hormona tiroidea de la que el cuerpo necesita.
La Glándula Tiroidea-
La tiroides es una glándula con forma de mariposa que se encuentra en el centro del cuello. Una tiroides saludable libera hormonas, llamadas triyodotironinas (T3) y tiroxina (T4). Cuando la glándula tiroides recibe un mensaje del cerebro indicando que el cuerpo necesita estas dos hormonas, las envía al torrente sanguíneo. La sangre entonces lleva hormona tiroidea a todas las partes del cuerpo.
Los síntomas que pueden producirse cuando disminuye la function de la glándula tiroides o cuando deja de producir suficiente hormona tiroidea incluyen:
- Inflamación en la parte frontal del cuello.
- Intolerancia al frío; tiene frío todo el tiempo.
- Se siente cansado y tiene sueño durante el día.
- Disminución del apetito.
- Estreñimiento.
- Crecimiento deficiente.
- Cabello áspero o frágil.
El hipotiroidismo
Tratamiento El hipotiroidismo se trata con una pastilla con hormonas. Las pastilla de hormona tiroidea que los doctores administran con frecuencia se llama Synthroid o Levothyroxine Sodium.
Es importante que se tome la pastilla a la misma hora todos los días como parte de su rutina cotidiana, de forma que que no olvide tomársela. Cada persona o familia debería encontrar la rutina adecuada que funcione en su caso.
Tenga cuidado y no le dé esta pastilla al mismo tiempo que el calcio o el hierro. Un niño que aún esté creciendo necesitará dosis distintas de hormona tiroidea a medida que se haga mayor.
Es posible que el doctor ordene que tenga una prueba de sangre antes o después de la citas clínicas para asegurar que la dosis sea la correcta. El doctor puede realizar cambios en la dosis de la pastilla basándose en los resultados de laboratorio de su hijo.
Los síntomas del hipotiroidismo desaparecerán con el tratamiento. Aún así es muy importante que siga tomando las pastillas para la tiroides.
Volverá a tener síntomas si deja de tomar las pastillas.
Síntomas de demasiada hormona tiroidea:
- Nerviosismo, no puede estarse quieto
- Irritabilidad
- Pérdida de peso
- Siente calor todo el tiempo
- Diarrea
- Insomnio, problemas para dormir
Visitas a la clínica
El doctor o la enfermera revisarán la función de la tiroides de varias maneras durante las citas.
Palpación –
el doctor le palpará la tiroides para ver si ha cambiado de tamaño o si un lado es más grande que el otro.
Reflejos –
El doctor le dará golpecitos en las rodillas, los tobillos, y los codos con un martillo de goma para ver si se producen contraccicones/sacudidas. Si el nivel de hormona tiroidea está bajo (hipo), es posible que los reflejos sean lentos. Si el nivel de hormona tiroidea está alto (hiper), los reflejos pueden ser rápidos.
Ritmo cardíaco –
El ritmo cardíaco puede ser más lento con el hipotiroidismo. Es posible que el ritmo cardíaco sea más rápido con el hipertiroidismo.
Presión arterial –
La presión arterial puede estar baja con el hipotiroidismo. La presión arterial puede estar alta con el hipertiroidismo.
Piel y cabello –
Es posible que tenga la piel y el cabello resecos y ásperos con el hipotiroidismo. Con el hipertiroidismo, la piel y el cabello pueden estar húmedos y grasos.
Estatura y peso –
Es posible que su hijo no crezca a un ritmo apropiado si tiene hipotiroidismo. Si tiene hipertiroidismo, es posible que crezca a un ritmo apropiado y también puede perder peso. Pesaremos y mediremos a su hijo durante las visitas clínicas para ver si su cuerpo está creciendo como debe.