Thyroid Disease in Children

Symptoms to look for if you suspect hypothyroidism or hyperthyroidism

Thyroid problems aren't rare in children, but they're also not as common as parents may believe. In kids, hypothyroidism, which occurs when the thyroid is underproducing thyroid hormone, is more common than hyperthyroidism, when the thyroid produces too much thyroid hormone.

There are several symptoms for both conditions that you may notice in your child that should prompt you to make an appointment with your pediatrician to see if a thyroid problem is actually the cause.

Symptoms and Causes

From congenital hypothyroidism and Hashimoto's thyroiditis to Graves' disease, children and teens can indeed develop thyroid problems. Thyroid and autoimmune issues are also often hereditary, so if you have a family history of these conditions and notice symptoms in your child, you should talk to your doctor sooner rather than later.

In the absence of such history, some parents may assume a thyroid issue because of the presence of certain signs and symptoms alone. But many of the hallmarks of thyroid disease overlap with several other—and completely separate—health issues.

If you're worried about thyroid issues because your child is overweight, it's important to keep in mind that children with thyroid problems that prompt weight gain are typically short. Kids who are overweight because they eat too much or exercise too little rarely owe their weight gain to a thyroid disorder.

Sleeping a lot is another common symptom that brings parents to their pediatrician looking for a thyroid problem. While that symptom usually warrants checking your child's thyroid function, without other symptoms, the tests are likely to be normal. Your doctor might look for other causes of excessive sleepiness, such as obstructive sleep apnea, depression, or mononucleosis.

Reviewing some of the common signs and symptoms of hypothyroidism and hyperthyroidism can help you know when to ask about getting thyroid function tests ordered for your child and when to look for another cause for your child's symptoms.

Hypothyroidism

hypothyroidism symptoms in kids
Illustration by Brianna Gilmartin, Verywell

Hypothyroidism most commonly occurs when the thyroid gland isn't producing enough thyroid hormone, either because it can't (primary hypothyroidism) or because it isn't being stimulated properly (secondary hypothyroidism).

Newborns with congenital hypothyroidism are usually identified on their newborn screening test, which routinely tests for hypothyroidism.

Kids with primary hypothyroidism will usually have a low free thyroxine level (free T4), an elevated level of thyroid stimulating hormone (TSH), and associated symptoms of hypothyroidism, such as:

  • Short stature or deceleration of growth
  • Rough, dry skin
  • Constipation
  • Cold intolerance
  • Fatigue and decreased energy
  • Sleeping more
  • Bruising easily
  • Delayed bone age on X-ray
  • Delayed puberty (teens)
  • Galactorrhea (white breast discharge)
  • Pseudoprecocious puberty (early puberty)
  • Headaches
  • Vision problems
Symptoms of Hypothyroidism

Hyperthyroidism

hyperthyroidism symptoms in kids
Illustration by Brianna Gilmartin, Verywell

In hyperthyroidism, also called thyrotoxicosis, there is an excess of thyroid hormones. Children with hyperthyroidism will usually have a high T4 and triiodothyronine (T3), and a low TSH.

Symptoms of hyperthyroidism can include:

  • Emotional lability, with your child being more likely to cry easily, be irritable or excitable, etc.
  • Short attention span
  • Finger tremor
  • Increased appetite
  • Weight loss, failure to thrive
  • Enlarged thyroid gland (goiter)
  • Exophthalmos (protruding eyes)
  • Upper eyelid lag
  • Infrequent blinking
  • Flushed skin
  • Excessive sweating
  • Muscle weakness
  • Tachycardia and palpitation
  • High blood pressure
Symptoms of Hyperthyroidism

When to See a Doctor

Whether you think your child's thyroid is underactive or overactive, talk to your pediatrician if you think their thyroid isn't working properly. Your pediatrician may also notice symptoms of thyroid problems when performing other check-ups on your child and recommend that they see a specialist.

As thyroid disorders are sometimes hard to diagnose and thyroid function tests can be hard to interpret, an evaluation by a pediatric endocrinologist can also be helpful.

Not all symptoms of thyroid problems are an immediate cause for concern—dry skin, for example, can be attributed to any number of things—so don't fret if your pediatrician wants to rule out other conditions before recommending thyroid testing, or takes a "wait and see" approach.

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Article Sources
  • Kliegman, RM, Stanton, B, St. Geme, J, Schor, NF. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016.
  • Melmed, S, Polonsky, KS, Larsen, PR, Kronenberg, HM. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016.