KidsMD Health Topics

Hyperthyroidism

  • Overview

    If your child is suddenly gaining or losing weight, has become irritable or depressed and is having trouble concentrating in school, it may be time to call the doctor. While these changes can be sparked by any number of events, they can be symptoms of an overactive thyroid—a condition known as hyperthyroidism.

    Hyperthyroidism occurs when the thyroid gland makes too much thyroxine (the hormone responsible for managing metabolism). This leads to an increased metabolism and affects many cells and tissues throughout the body, including the brain, heart, bone, skin and intestinal tract.

    • In infants younger than 3, too much thyroid hormone can result in cognitive delay.
    • Hyperthyroidism is less common in children and adolescents than it is in adults.
    • In older children, the most common cause of hyperthyroidism is Graves’ disease an autoimmune disorder in which a child’s immune system erroneously attacks his thyroid gland..
    • In newborns, the most common cause of an overactive thyroid is neonatal Graves’ disease, which is a temporary condition.


    How Children’s Hospital Boston approaches hyperthyroidism

    The Thyroid Program at Boston Children's Hospital is one of the only centers in the United States devoted exclusively to the care of children with thyroid disease. Our clinicians and staff are not only dedicated, experienced clinicians; they are also involved in numerous studies about the various aspects of thyroid disease and thyroid function in childhood.?
    The program assists kids of all ages with hyperthyroidism—as well as their families—by providing:
    comprehensive diagnostic and evaluation services
    child- and family-centered treatment plans
    long-term monitoring and follow-up

    In addition, Children’s Thyroid Program clinicians work closely with other thyroid specialists across the greater Boston area, including experts at Brigham and Women’s Hospital and Dana-Farber Cancer Institute.

    A very special center for pediatric autoimmune disease? The Samara Jan Turkel Clinical Center for Pediatric Autoimmune Disease at Children’s is the first of its kind in the country providing comprehensive diagnosis and treatment plans, along with clinical care for outpatient and inpatient treatment. Read more.

    Reviewed by Stephen Huang, MD,

    © Children’s Hospital Boston; posted in 2011

    Boston Children's Hospital 
    300 Longwood Avenue
    Boston MA 02115
     617-355-7476

  • In-Depth

    What is the thyroid gland? How does it work?

    The thyroid is a small, butterfly-shaped gland in the neck that helps regulate how quickly or slowly the body uses energy. In other words, it’s key to a person’s metabolism.

    The thyroid helps to regulate metabolism through the production of thyroxine, or T4. This hormone also plays an important role in the normal growth and brain development of children. Levels of T4 are in turn regulated by thyroid-stimulating hormone (TSH), which is produced in the brain. ??TSH is much like the thermostat in your home: If the T4 level is too low, TSH sends a message to the thyroid gland to make more T4, just like the thermostat activates the furnace to produce more heat if the house is too cold.

    What are some of the possible complications of hyperthyroidism?
    Eye problems: Graves’ ophthalmopathy is an eye condition associated with Graves’ disease. It can cause red, swollen and bulging eyes, as well as sensitivity to light and double vision.

    Heart problems: A rapid heart rate, irregular heartbeat and congestive heart failure are all serious potential complications of hyperthyroidism. Fortunately, these complications can be avoided with prompt and adequate treatment.

    Osteoporosis: Hyperthyroidism can lead to thinning or brittle bones, or osteoporosis. This is because excess thyroid hormone prevents the body from using calcium, a bone-strengthening mineral.

    Skin problems: Graves’ dermopathy is a rare condition in which the skin, often on the child’s shins and feet, becomes red and swollen.

    Thyrotoxic crisis (“thyroid storm”): This is a sudden onslaught of symptoms such as rapid heart rate and fever. If you think your child is experiencing a thyrotoxic crisis, you should always seek immediate medical care.

    What causes the bulging eyes that are frequently associated with hyperthyroidism?
    In Graves’ disease, the antibodies that stimulate the thyroid gland can sometimes interact with tissues behind the eye, leading to swelling and causing the bulging-eyed appearance some people with hyperthyroidism have.

    Did you know?
    Boston Children’s Division of Endocrinology has been #1 in the nation by U.S. News & World Report.

    Causes

    What causes hyperthyroidism?
    There are several possible causes for the condition:

    Graves’ disease: The most common cause of hyperthyroidism in children and adolescents is Graves’ disease. This is an autoimmune disorder in which the body produces antibodies that stimulate the thyroid gland to produce more and more thyroid hormone.

    Neonatal Graves’ disease: In newborns, the most common cause of hyperthyroidism is neonatal Graves’ disease. This happens after the mother passes the thyroid-stimulating antibodies to her child, causing the baby to have a temporary case of hyperthyroidism (or until the antibodies are cleared from the baby’s circulation).

    Thyroid nodules: Rare in children, thyroid nodules are growths in the thyroid gland that are usually benign, meaning they do not cause cancer. Sometimes, these growths produce thyroid hormones that can lead to hyperthyroidism.

    Thyroiditis: Sometimes, the thyroid gland can become inflamed, which can lead to excess thyroid hormone leaking into the blood. This condition is known as thyroiditis and is rare in children.

    Signs and symptoms

    How can I tell if my child might have an overactive thyroid?

    The most common signs and symptoms of hyperthyroidism are:

    • difficulty gaining weight
    • fast or irregular heartbeat
    • high blood pressure
    • nervousness and trouble concentrating
    • irritability
    • bulging eyes
    • diarrhea
    • poor school performance
    • infants may have trouble breathing (caused by an enlarged thyroid gland pressing on the windpipe)
    Giving thanks to a special Endocrinology nurse
    Linda Darling thanks Virginia Rich, RN, from Children’s Endocrinology Division for having a "positive impact" in her son’s life. Read her letter

    Questions to ask your doctor

    You and your family play an essential role in your child’s treatment for hyperthyroidism. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.

    You’ve probably thought of many questions to ask about your child’s condition and prognosis. It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you will have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you. (If your child is old enough, you can encourage him or her to write down questions, too.)? ?Initial questions to ask your doctor might include:

    • How did you arrive at this diagnosis?
    • Are there any other conditions my child might have instead of hyperthyroidism?
    • What do you think caused my child’s hyperthyroidism?
    • Does he have any other disorders or complications?
    • How should I talk to my child about her condition?
    • How should I explain my child’s hyperthyroidism to others?
    • Do I need to make any other changes to my child’s home and school routines?
    • What other resources can you point me to for more information?
    • What treatment approach do you feel is best for my child, and why?
    • Does my child need medication? If so, what are the possible side effects?
    • Will my child need to have surgery?
    • What precautions do I need to take as far as my child’s diet and exercise?
    • How can I help my child be more comfortable?
    • If my child is struggling with his illness, should he talk to a therapist?
    Did you know?
    You can easily keep family and friends up to date on your child’s care and hospitalization by setting up a free Children’s CarePage.

    FAQ

    Q: Could I have done something to prevent my child’s hyperthyroidism?

    ?A: No. If your child has Graves’ disease—as many children with hyperthyroidism do—there was no way to prevent his thyroid from becoming overactive. Graves’ disease is caused by a malfunction in a child’s immune system. While there is a genetic component to the condition, no individual gene triggers Graves’ disease. Experts believe a combination of genetics and environmental factors are responsible.
    The other common causes of hyperthyroidism—thyroid nodules and thyroiditis—are also not preventable.

    Q: What is “thyroid storm," and how do I look out for it in my child’s case?

    ?A: "Thyroid storm," or thyrotoxic crisis, is a very serious complication of hyperthyroidism. It occurs when a child’s thyroid hormone levels become severely elevated. Though thyroid storm is rare, when it does occur, it can be life-threatening. The most important symptom to look out for is a very high temperature (up to 105 or 106 degrees Fahrenheit). If you suspect your child may be experiencing thyroid storm, you should always seek immediate medical care.

    Q: If I have another child, is he or she at risk of developing hyperthyroidism too??

    A: The answer depends on your child’s specific type of hyperthyroidism. If he has an overactive thyroid caused by a nodule or thyroiditis, it is unlikely other members of his family—including siblings—will have hyperthyroidism. However, if he has been diagnosed with Graves’ disease—the most common cause of childhood hyperthyroidism—there is a possible genetic link.
    Graves’ disease is a genetic autoimmune disorder, meaning that genes play a role in the onset of the disease (although there is no one gene that has been identified as the culprit). If your child has been diagnosed with Graves’ disease, you and other members of your family should have your thyroid levels checked as a precaution.??

    Q: Can dietary changes make a difference for my child??

    A: No dietary regimen can prevent or cure hyperthyroidism. However, it’s important for your child to follow a healthy and nutrient-rich diet that does not contain excessive amounts of iodine. Since hyperthyroidism can cause unwanted weight loss if not properly treated, always make sure your child is taking in enough healthy calories (the weight loss should stop once the hyperthyroidism is being treated).
    If your child has also been diagnosed with celiac disease, you should carefully adhere to your doctor’s recommendations for a gluten-free diet.

    Q: Does my child need to cut back on sports or other physical activities?

    ?A: If your child’s hyperthyroidism is not properly under control, she might experience rapid heart rate or fatigue. Any time she has these symptoms, you should contact your doctor right away. ??Another possible complication of hyperthyroidism is osteoporosis, which leads to brittle bones that are more susceptible to breaks and bruises. For all of these reasons, always ask your child’s doctor for recommendations and guidelines about taking part in sports and play.
    Once her hyperthyroidism is being managed, and if there are no other complications, your child will most likely be able to resume her normal physical activities just like any other kid her age.

    Q: Will hyperthyroidism affect my child’s appearance or mood?

    ?A: Before your child’s hyperthyroidism is diagnosed and being managed, he may appear underweight or “peaked.” Other physical symptoms can include bulging eyes or Graves’ dermopathy, the development of red, swollen skin (most often on the shins and feet). Because an overactive thyroid increases metabolism to an excessive level, your child may also feel (and act) anxious, restless and irritable. If these symptoms do not clear up with treatment, you should ask your doctor whether your child might benefit from talking to a therapist or other behavioral health professional.

    Q: Will my child still enjoy a good quality of life?

    A: Yes. The good news is that, with the right diagnosis and management, hyperthyroidism is a very treatable disease, and your child can go on to live a full, active and enjoyable life.

    The Scoop on vitamin D
    Originally known as a vitamin that aids the body's absorption of calcium, vitamin D is gaining increasing attention for its role in maintaining good health and preventing disease. But despite its benefits, many children still do not receive adequate vitamin D. Read one Children’s endocrinologist’s suggestions.
  • Tests

    How is hyperthyroidism diagnosed?

    If your doctor suspects your child may have an overactive thyroid gland, she will start the diagnostic process with a complete medical history, followed by a physical exam. ??Some of the signs that may point to hyperthyroidism are a rapid heartbeat, eye changes, excessive weight loss and overactive reflexes. To confirm a diagnosis of hyperthyroidism, your doctor will typically:?

    • check levels of your child’s thyroid hormone and thyroid-stimulating hormone (TSH) with a blood test
    • measure the level of thyroid-stimulating antibodies in the blood
    • perform thyroid imaging studies, such as a thyroid scan.
    Did you know?
    A thyroid scan is a nuclear medicine test that allows your child's doctor to determine the size, shape, function and position of her thyroid gland. Read more.

    Treatment and care

    There are three types of treatment for hyperthyroidism: antithyroid drugs, radioactive iodine and surgery. ?
    Antithyroid drugs work by blocking the thyroid glands ability to make thyroid hormone. These drugs to not damage the thyroid gland.

    Radioactive iodine is absorbed by the thyroid gland, causing it to shrink. This destroys part of the thyroid gland but does not affect other parts of the body. Your child may need medication to replace the thyroxine that is no longer produced.

    Surgery, or removal of part of the thyroid gland, is a rare form of treatment and will require lifelong treatment with medication to replace levels of thyroid hormones.  

    In infants with neonatal Graves’ disease, treatment with antithyroid drugs is temporary and is continued until the mother’s thyroid-stimulating antibodies have been cleared from the baby’s circulation.

    Looking for more information about thyroid disease?
    Visit the American Thyroid Association’s web site for comprehensive information about all types of thyroid conditions.
  • How is hyperthyroidism treated?

    Fortunately, with prompt treatment, babies usually recover completely within a few weeks. However, hyperthyroidism may recur during the first 6 months to 1 year of a baby's life, so it's important to be vigilant.

    The goal of treatment is to restore the thyroid gland to normal function, producing normal levels of thyroid hormone. Components of your child's treatment may include:

    • medication that blocks the production of thyroid hormones
    • treatment for heart failure

    Coping and support


    It's normal for you to have many questions when your child is dealing with hyperthyroidism: Will it affect my child long term? What do we do next? We've provided some answers to those questions on these pages, and our experts will explain your child's condition in more detail.
    Our team in Boston Children's Hospital's Thyroid Program will help your family navigate the challenges of living with a child's chronic medical condition. Our psychosocial team includes staff from the Departments of Nursing, Child Life and Social Work. In addition, Children's has several other resources designed to give your family comfort, support and guidance:

    Children's Center for Families is dedicated to helping families locate the information and resources they need to better understand their child's particular condition and take part in their care. All patients, families and health professionals are welcome to use the center's services at no extra cost. The Center for Families is open Monday through Friday from 8 a.m. to 7 p.m., and on Saturdays from 9 a.m. to 1 p.m. Please call 617-355-6279 for more information.?

    The Experience Journal was designed by Children's psychiatrist-in-chief David DeMaso, MD, and members of his team. This online collection features thoughts, reflections and advice from kids and caregivers about going through a variety of medical experiences.?

    Children's Department of Psychiatry offers a free booklet, “Helping Your Child with Medical Experiences: A Practical Parent Guide” (Please note that Adobe Acrobat is required to view and download the guide.) Topics in the booklet include:

    • talking to your child about his or her condition
    • preparing for surgery and hospitalization
    • supporting siblings
    • taking care of yourself during your child's illness
    • adjusting to life after treatment?
    • Children's Behavioral Medicine Clinic helps children who are being treated on an outpatient basis at the hospital—as well as their families—understand and cope with their feelings about:
    • being sick
    • facing uncomfortable procedures
    • handling pain
    • taking medication
    • preparing for surgery
    • changes in friendships and family relationships
    • managing school while dealing with an illness
    • grief and loss?

    Children's Psychiatry Consultation Service provides several services, including:

    • short-term therapy for children admitted to one of our inpatient units
    • parent and sibling consultations
    • teaching healthy coping skills for the whole family
    • educating members of the medical treatment team about the relationship between physical illness and psychological distress?

    The Children's chaplaincy is a source of spiritual support for parents and family members. Our program includes nearly a dozen clergy members—representing Episcopal, Jewish, Lutheran, Muslim, Roman Catholic, Unitarian and United Church of Christ traditions—who will listen to you, pray with you and help you observe your own faith practices during your child's treatment. ?

    Children's International Center is a dedicated resource for patients and families from countries outside the United States. The center can provide assistance with everything from reviewing medical records to setting up appointments and locating lodging. Contact the center by phone at 01-617-355-5209 or via e-mail at international.center@childrens.harvard.edu.

     

    View a general guide for Children's patients and their families?
    On our For Patients and Families site, you can find all you need to know about:
    • getting to Children's
    • accommodations
    • navigating the hospital experience
    • other resources that are available for your family
  • Research & Innovation

    At Children’s Hospital Boston, our care is informed by our research, and our discoveries in the laboratory strengthen the care we provide at each child's bedside. Children’s scientific research program is one of the largest and most active of any pediatric hospital in the world. In particular, our cardiovascular and cardiac surgery researchers are discovering insights into the causes and development of heart defects and disorders; paving ground for the promising new treatments and interventions; and offering ideas and discoveries that could lead to better treatments and cures.??The Thyroid Program at Children’s Hospital is involved in numerous research activities that focus on thyroid disease in children, designed to better understand the causes of these disorders and how to best treat them. Among our current research projects are studies of:

    • the relationship between TSH receptor antibodies and the onset of thyroid disease
    • the causes and prognosis of congenital hyperthyroidism (thyroid disease present at birth)
    • the metabolism of thyroid hormone

    Learn more about our ongoing research efforts.

    Clinical trials?

    Children’s is known worldwide for pioneering some of the most effective diagnostic tools, therapies and preventive approaches in pediatric medicine. A significant part of our success comes from our commitment to research—and to advancing the frontiers of health care by conducting clinical trials.
    Children’s coordinates hundreds of clinical trials at any given time. Clinical trials are studies that may involve:

    • evaluating the effectiveness of a new drug therapy
    • testing a new diagnostic procedure or device
    • examining a new treatment method for a particular condition
    • taking a closer look at the causes and progression of specific diseases?

    We are involved in several multi-site clinical trials and studies focusing on endocrinological disorders in childhood. While children must meet strict criteria in order to be eligible for a clinical trial, your child may be a candidate for participation in a study. Before considering this option, you should be sure to:

    • consult with your child’s treating physician and treatment team
    • gather as much information as possible about the specific course of action outlined in the trial
    • do your own research about the latest breakthroughs relating to your child’s condition

    Taking part in a clinical trial at Children’s is entirely voluntary. Our team will be sure to fully address any questions you may have, and you may remove your child from any medical study at any time.
    Search current and upcoming clinical trials at Children’s.            
    Search the National Institute of Health’s list of clinical trials taking place around the world.

    Are you reading Vector?
    Follow the Vector blog for the latest information about basic, translational and clinical research at Boston Children's Hospital.
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Doctors Who Treat "Hyperthyroidism"

The future of pediatrics will be forged by thinking differently, breaking paradigms and joining together in a shared vision of tackling the toughest challenges before us.”
- Sandra L. Fenwick, President and CEO
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