In pediatric endocrinology, thyroid diseases are extremely common. In some regions of our country, the incidence is quite high. The danger of these pathologies is that they can lead to the appearance of the most unfavorable clinical symptoms in the baby. Our article will tell you about childhood hyperthyroidism.
What it is?
Hyperthyroidism is not a disease, but a pathological condition. It can be caused by various diseases of the thyroid gland. An increase in the amount of peripheral thyroid hormones - T3 and T4 with a decrease in TSH (pituitary hormone) indicates the presence of thyrotoxicosis in the body. This pathological condition is often recorded in both children and adults. Boys get sick as often as girls.
Healthy thyroid tissue consists of numerous cells - thyrocytes. These powerful energy stations produce specific hormones that have a pronounced systemic effect on the entire body. Thyrocytes are grouped into special anatomical formations - follicles. Between adjacent follicles there are sections of connective tissue in which nerves and blood vessels are located, which carry out the trophism of the thyroid gland.
Normally, peripheral thyroid hormones have a significant effect on the functioning of many internal organs. They affect the number of heartbeats per minute, help keep blood pressure within the age range, participate in metabolism, and affect mood and nervous activity. With age, the amount of peripheral hormones changes somewhat. This is due to the physiological characteristics of the human body.
Due to the active growth and development of the child, the level of peripheral hormones is quite high.
Causes
Various pathological conditions lead to the development of increased production of peripheral thyroid hormones in a baby. Today, thyroid diseases in pediatric endocrinology come to the fore. Their treatment is quite long and in some cases it can even last for several years.
The development of an increase in the blood level of T3 and T4 in a child is facilitated by:
- Diffuse toxic goiter or Graves' disease. This condition is characterized by a pronounced enlargement of the thyroid gland. In the development of the disease, heredity plays an active role. The disease proceeds with the appearance of pronounced metabolic systemic disorders. Diffuse enlargement of the thyroid gland contributes to an increase in the level of peripheral hormones in the blood.
- Nodular goiter. This disease is characterized by the appearance of dense areas in the healthy tissue of the thyroid gland. Most often, this pathology is associated with the lack of iodine in the baby's diet. The disease is endemic, that is, it occurs in regions very remote from the sea. The first signs of the disease can develop in babies aged 6-7 years.
- Congenital forms. This pathology is formed during the period of intrauterine development. This usually occurs during a complicated pregnancy of a woman who suffers from diffuse toxic goiter. According to statistics, 25% of subsequently born babies have signs of clinical or subclinical thyrotoxicosis.
- Neck injuries. Traumatic injuries of the cervical vertebrae contribute to mechanical damage to the tissue of the thyroid gland, which contributes to the further appearance of signs of thyrotoxicosis in the child.
- Thyroid neoplasms. Growing benign or malignant tumors contribute to the disruption of the endocrine organ, which is accompanied by the appearance of clinical signs of thyrotoxicosis in the child.
The most common pathology that leads to the appearance of thyrotoxicosis in a child is diffuse toxic goiter. With this pathology, an increase in the size of the thyroid gland occurs. It can be insignificant or appear quite bright.
Endocrinologists distinguish several degrees of thyroid enlargement:
- 0 degree. It is characterized by the absence of any clinical and visible signs of goiter.
- 1 degree. The size of the thymus tissue exceeds the distal phalanx of the baby's thumb, which is being examined. On visual inspection from the side of local enlargement of the thyroid gland is not observed. Thymus elements are detected in the baby only during palpation.
- 2nd degree. On visual inspection and palpation, the goiter is very well defined.
Symptoms
Impaired work of the thyroid gland leads to the appearance in a sick child at once of many different clinical signs. Their severity can be different. With an active course of hyperthyroidism and a significant excess of peripheral hormones T3 and T4, the adverse symptoms of the disease are significantly pronounced.
In some cases, hyperthyroidism practically does not manifest itself clinically. This indicates the presence of a subclinical course. In this case, it is possible to detect abnormalities in the functioning of the thyroid gland only by conducting laboratory tests and determining peripheral hormones.
When a child develops numerous adverse symptoms, doctors say that he has a clinical form of hyperthyroidism.
The most common clinical signs of the disease are as follows:
- Rapid pulse or heart problems. Often this is manifested by the appearance of an excessively accelerated pulse after minor physical or psycho-emotional states. With a pronounced course of hyperthyroidism, the heart rate also increases in a state of complete rest.
- Blood pressure surges. Systolic (upper) blood pressure usually increases. Diastolic (lower) in most cases remains within normal limits. These conditions, characteristic of hyperthyroidism, also contribute to an increase in pulse pressure.
- Behavior changes... The child becomes overly aggressive, easily excitable. Even a little criticism can lead to a violent response. Typically, these mood swings are most pronounced in adolescents. Some children have real short bursts of anger.
- Limb tremor. It is a classic symptom of severe clinical hyperthyroidism. It is detected during a clinical examination by a doctor of any specialty. Hand tremors (tremors) are usually tested when the toddler extends both arms forward with his eyes closed. Usually hand tremors are shallow, not sweeping.
- Eye symptoms. Manifest in the form of exophthalmos (a slight protrusion of the eyeballs), too wide opening of the eyes, rare blinking, various convergence disorders (the ability to focus on objects) and other specific signs. The attending physician checks the child for these symptoms during the clinical examination. Not only pediatric ophthalmologists, but also district pediatricians are skilled in determining these clinical signs in babies.
- Sleep disturbance. This symptom manifests itself in babies of different ages. It usually manifests itself well in children aged 3-7 years. The baby is very difficult to put to bed, he often wakes up in the middle of the night. Often the child is disturbed by nocturnal noises that make him get up several times during the night.
- Pathological mood enhancement. In some cases, a child with signs of thyrotoxicosis has spontaneous outbursts of intense joy and even euphoria. Typically, these episodes are short-lived and can be followed by severe aggressive behavior. The baby's mood is evened out after the appointment of special medications.
- Pronounced pulsation in the vessels of the neck. This symptom is associated with changes in hemodynamics. An increase in pulse pressure leads to a strong blood filling of the main, as well as peripheral blood vessels. Usually this symptom is clearly visible on the vessels of the neck.
- Disorders of the gastrointestinal tract... To a greater extent, in babies, this symptom manifests itself in the form of frequent diarrhea. The child can go to the toilet several times a day. Long-term diarrhea leads to various disorders in metabolic processes and negatively affects the work of the entire digestive system.
- Increased appetite. A child with hyperthyroidism constantly wants to eat. Even if the child ate well at lunch or dinner, then after a few hours he is again very hungry. The baby has a constant feeling of "wolf hunger". At the same time, the baby does not gain extra pounds at all, but, on the contrary, loses weight.
Diagnostics
If the parents have any suspicions that the child has signs of hyperthyroidism, you should definitely show the baby to the doctor. If possible, consult a pediatric endocrinologist. This doctor will be able to carry out all the necessary complex of diagnostic measures that will help establish the correct diagnosis.
Hyperthyroidism is easy to establish. To identify clinical forms, a detailed clinical examination is carried out, including mandatory palpation of the thyroid gland, as well as auscultation of the heart to detect cardiac disorders. After the examination, the doctor prescribes a number of laboratory tests that are needed to confirm the previously established diagnosis. These include the determination of peripheral thyroid hormones T3 and T4, as well as the quantitative measurement of the hormone TSH in the blood.
In hyperthyroidism, the content of T3 and T4 exceeds the age norms, and the TSH level decreases inversely.
To establish the clinical form of the disease, the doctor may additionally prescribe tests to identify specific antibodies to the thyroid tissue. Usually, this analysis is informative for establishing autoimmune pathologies of this endocrine organ.
To identify functional disorders, doctors also use additional diagnostic methods. They necessarily include cardiac electrocardiography. The ECG allows you to detect any disturbances in the heart rhythm, manifested by sinus tachycardia or various forms of arrhythmias. To identify concomitant complications, the baby can also be sent for consultation to a neurologist and ophthalmologist.
Treatment
Therapy for hyperthyroidism is largely aimed at normalizing elevated levels of peripheral thyroid hormones. For this, various drugs are used that have a therapeutic effect on thyrocytes.
The choice of the treatment regimen remains with the attending physician and is selected strictly taking into account the underlying pathology of the thyroid gland in the child, which was the reason for the development of hyperthyroidism.
To normalize the increased content of peripheral hormones in the blood, the following are used:
- Antithyroid drugs. They help manage clinical hyperthyroidism. They can be prescribed for a long-term appointment. These drugs have pronounced side effects, so they are usually not prescribed for use throughout life. During the treatment, the level of leukocytes in the general blood test is regularly monitored.
- Radioactive iodine. It is used when the early conservative treatment is ineffective. The implementation of this technique is possible only in the conditions of special departments designed for radiotherapy. To normalize the condition and eliminate clinical signs of hyperthyroidism, a course of treatment with radioactive iodine preparations is prescribed. The effectiveness of the method is quite high, however, in some cases, a relapse of the disease is possible.
- Beta blockers. These medicines decrease heart rate and restore normal heart rates. They are prescribed for severe clinical hyperthyroidism and are used for a course admission. When you feel better, medications are canceled.
- Normalization of the daily routine. All babies with clinical signs of hyperthyroidism should avoid strong physical and psycho-emotional stress. Excessive stress at school can lead to a deterioration in the child's well-being and prolonged persistence of signs of hyperthyroidism.
For information on what hyperthyroidism is in children, see the next video.
