Thyroid hormones that are produced in thyroid gland, which is located on mid-line of the neck and has a butterfly shape, play a critical role for many functions of the body. It is not possible to visualize and palpate it with examination in children unless the thyroid gland is oversized. However, when it enlarges, it becomes visible when head is at normal position or -sometimes- only when the head is tilted backwards (when the neck is at extension position) and felt with palpation. Abnormal enlargement of the thyroid gland is called ‘Goiter’. Not every clinical picture of goiter causes impairment of thyroid gland functions; in other words, if an individual has goiter but the thyroid hormones are within normal ranges, use of medication is not a must.
Similarly, thyroid gland may not function properly even in absence of goiter and production of thyroid hormones may be inadequate, a condition called hypothyroidism. In this case, thyroid hormone replacement should be employed.
Thyroid hormones affect the growth and development, use of oxygen in body, heat production, neural functions and use of glucose, fat, protein and vitamin in the body. Thyroid hormones are absolutely necessary especially for central nervous system and mental development in the first two years of life. Cases of congenital hypothyroidism are diagnosed and treated early in our country thanks to the national screening program.
Insufficient production of thyroid hormones is called hypothyroidism while hyperthyroidism implies the excessive production. Certain clinical symptoms emerge in both conditions. Hypothyroidism is more common in childhood comparing to hyperthyroidism.
Poor exercise capacity, slowed down movements, chilling, constipation, hair loss, somnolence and perception disorder are among the remarkable signs of hypothyroidism. Slowed down growth is the most severe symptom in childhood. In this case, continuing weight gain in spite of slow increase in length is an important hint. In hyperthyroidism, on the other hand, potential symptoms are weight loss, bad temper, palpitation, tremor in hands and diarrhea. Goiter can be detected in both hypothyroidism and hyperthyroidism, although not necessarily.
What is Hashimoto’s Disease?
Hashimoto’s disease (thyroiditis) or chronic lymphocytic thyroiditis is an autoimmune disease. In this disease, the immune system produces some antibodies against the thyroid gland (somewhat like attacking the thyroid gland) and may cause some structural and functional alterations in the thyroid gland. Its prevalence is higher in women and it is more common in adolescence.
Hashimoto thyroiditis may, sometimes, slow down functioning of the thyroid gland; besides, the clinical signs of the disease are much likely those that are caused by thyroid hormone deficiency. However, sometimes, those findings do not emerge. The only finding is enlargement of the thyroid gland, or in other words, goiter. As mentioned above, goiter may be manifested by a lump in the neck.
Hashimoto thyroiditis has no specific treatment; the actual treatment is the replacement of deficient thyroid hormones when the thyroid gland does not function well.
Surgery or laser therapy is not recommended to treat Hashimoto’s thyroiditis in children.
Laboratory and imaging tests in thyroid gland diseases
- TSH (produced by pituitary gland in brain), T4 and T3 (thyroid hormones produced by thyroid gland) levels in blood
- Levels of auto-antibodies, anti TPO and anti Thyroglobulin, in blood for selected cases
- Thyroid ultrasound
- Thyroid scintigraphy and fine needle aspiration biopsy in a few cases (for certain thyroid nodules)
How are thyroid gland disorders managed?
- Thyroid hormone therapy in case of hypothyroidism (oral pills to be used every day)
- In hyperthyroidism, anti-thyroid medications are used in the form of oral pills to suppress the thyroid hormone levels.
- Suspension and drop forms of those medications are also available in our country.
- Duration of therapy may vary for each patient.