Thyroid disease in children: warning signs. What parents should know if their child has an enlarged thyroid gland

Diffuse toxic goiter (DTG), or thyrotoxicosis (Graves' disease), is an autoimmune disease characterized by hyperplasia of the thyroid gland (TG) and increased synthesis of thyroid hormones.

Among children, the disease is more common in adolescents (from 10 to 15 years old), boys are affected by the disease 8 times less often than girls. The incidence of adolescents is about 24% of the total incidence. Congenital DTG is recorded in rare cases in infants.

Among the predisposing factors, the leading role is played by psycho-emotional stress and depressive disorders The child has.

The basis for the development of DTG is a hereditary predisposition associated with many genes. DTG occurs more often in those children whose parents have this pathology.

Many factors can provoke the development of DTG in children:

infections (often yersiniosis) and bacterial diseases, acute and chronic (sinusitis, tonsillitis, etc.);
emotional stress, stressful situations, depression;
excessive insolation ( long stay under direct sunlight);
traumatic brain injury;
in food;
excessive physical activity;
hypothermia;
failure in the immune system for any reason.

The development of DTG can also provoke diseases such as vitiligo, pathology of the adrenal glands.

DTG develops as a result of an autoimmune process: the body produces antibodies to the thyroid-stimulating hormone of the pituitary gland, which controls the function of the thyroid gland. As a result, the thyroid gland uncontrollably produces an excess amount of its hormones. Hyperfunction of the thyroid gland in this case develops without inflammation of the gland tissue.

The thyroid gland can also be affected, among other glands, in Schmidt's polyendocrine syndrome (together with the pancreas, ovaries, testicles, adrenal glands, parathyroid glands).

Symptoms

The development of the disease is gradual, periods of exacerbations and remissions are possible. The first manifestations are often in children touchiness, tearfulness, irritability, even aggressiveness. The child is constantly fussing, overly talkative, with difficulty concentrating attention. Decreased school performance.

A teenager suffers from persistent headaches. The child does not tolerate heat well. Excessive sweating protects the body from overheating. Often in the evenings, the temperature rises slightly (not higher than 37.5 0 C).

The manifestations of DTG in children are very diverse - they reflect the defeat of many systems: cardiovascular, digestive, nervous, organ of vision. Under the influence high level thyroid hormones disrupt all types of metabolism.

Main clinical manifestations DTZ:

Defeat nervous system characterized by numerous symptoms:

irritability and increased excitability of the child;
emotional lability, mood instability, impressionability, tearfulness;
increased fatigue;
sleep disturbance;
autonomic disorders in the form of a feeling of heat, sweating, trembling of the eyelids, fingers, tongue (and sometimes the whole body); handwriting deteriorates due to tremor;
possible twitching of the limbs, impaired coordination.

Pathology of cardio-vascular system manifests itself:

heart attacks;
increased heart rate (still during sleep);
arrhythmia in the form of extrasystoles;
sensation of pulsation in the limbs, head, epigastric region;
shortness of breath;
an increase in systolic (upper indicators) with a decrease in diastolic (lower indicators) blood pressure;
expansion of the boundaries of the heart and insufficiency mitral valve on the late stages illness.

The defeat of the gastrointestinal tract give out the following signs:

with increased appetite;
thirst;
stomach ache;
the stool is quickened due to intestinal hypermotility, but is formed (sometimes mushy), and diarrhea is not characteristic;
nausea;
an increase in the liver, thyrotoxic autoimmune hepatitis often develops with jaundice and an increase in liver enzymes;
biliary dyskinesia.

Damage to the organ of vision (ophthalmopathy) reflects the symptoms:

exophthalmos (bulging eyes);
palpebral fissures are widely opened;
swelling and pigmentation of the eyelids;
excessive shine of the eyes;
jitter eyeballs;
rare blinking;
violation of the tone of the muscles of the eyes ( upper eyelid lags behind the eyeball when looking down), the eyelids do not close even during sleep;
convergence disorder.

Often there is a feeling of sand in the eyes, lacrimation, photophobia, double vision rarely appears. When smoking, the severity of these symptoms is exacerbated. All eye symptoms are diagnostic.

With the development of DTG, the thyroid gland always increases. But the severity of the disease does not depend on its size.

When the gland is felt, a pulsation is determined, and with the help of a stethoscope, the doctor listens to vascular noises. An enlarged gland can cause a change in voice, make breathing or swallowing difficult. In adolescents, due to an increase in the gland, there is a feeling of squeezing the neck, so they try not to wear sweaters with a high collar, unbutton the top button on their shirt.

Enlargement of the gland (goiter) is more often diffuse, but it can also be diffuse-nodular due to cysts or malignant tumor. In these cases, a scan is necessary to clarify the diagnosis.

The skin with DTG is tender, warm, moist, the palms are also typical - hot and moist. Often appears pruritus. Hair and nails in children have increased fragility.

With thyrotoxicosis, damage to other endocrine glands often develops, which is manifested by dysfunction of the gonads (menstrual irregularities and late development of secondary sexual characteristics in girls), symptoms of diabetes mellitus, hypocorticism (adrenal hormone deficiency). In young men, potency and libido may decrease, but secondary sexual characteristics are developed normally, sometimes gynecomastia (enlarged mammary glands) develops.

Complications

One of the most dangerous complications DTG is a thyrotoxic crisis. It may occur when severe course Graves' disease. Its development is noted in 2-8% of adolescents suffering from thyrotoxicosis.

Crisis can be triggered by:

infections;
severe stress;
operation;
injury;
cancellation of thyreostatics;
radioiodine treatment.

Symptoms of a thyrotoxic crisis are:

high fever;
increased heart rate up to 200 bpm;
violation of the heart rhythm by the type of atrial fibrillation;
excessive excitement and anxiety up to psychosis;
diarrhea and vomiting;
increase in the amount of urine per day;
progressive dehydration of the body;
muscle weakness up to paresis;
lowering blood pressure;
jaundice;
impaired consciousness (possible coma);
heart and adrenal insufficiency, leading to death (in 20-25% of cases).

Other possible complications of DTG:

damage to the retrobulbar tissue (located behind the eyeball) in the form of scars can lead to irreversible ophthalmic disorders;
bulging and infection of the eye can lead to clouding of the cornea (the formation of a thorn);
squeezing the trachea with a goiter can provoke the development of reflex bronchial asthma;
symptomatic diabetes: an increase in blood sugar is associated with inhibition of the process of converting glucose into fats and increased absorption of glucose in the intestine under the action of thyroid hormones (with recovery from thyrotoxicosis, diabetes disappears);
formation arterial hypertension in adolescents;
if unsuccessful surgical treatment possible development of hypothyroidism (insufficiency of thyroid function), aphonia (loss of voice) as a result of damage recurrent nerve.

Classification

There are such degrees of enlargement of the thyroid gland:

I degree: the increase is not visible during examination, but the isthmus of the gland is palpated;
II degree: the gland is noticeable when swallowing;
III degree: the gland is clearly visible, it fills the space between the left and right sternocleidomastoid muscles;
IV degree: significant enlargement of the gland;
V degree: the huge size of the gland.

Thyrotoxicosis severity can be:

mild degree: the number of heartbeats is up to 100 per minute, body weight is reduced to 20%, an increase in basal metabolism is about 30%, eye symptoms not yet;
moderate degree: pulse rate up to 130 bpm, body weight loss is 30%, basal metabolism is increased by 60%, eye symptoms are clearly expressed;
the severe degree is characterized by the highest parameters of tachycardia, weight loss and increased metabolism, the appearance of mental reactions, dystrophic changes in the organs.

According to another classification, the following stages of thyrotoxicosis are distinguished:

neurohumoral stage: there is a toxic effect on the body of an excess amount of hormones synthesized by the gland;
visceropathic: characterized by pronounced pathological changes functions of internal organs;
cachectic: there is an exhaustion of the body, changes in internal organs can be irreversible - in the absence of immediate help, it can end fatally.

Diagnostics

A child with suspected DTG must undergo an ultrasound of the thyroid gland.

It is possible to suspect DTG in a child on the basis of an examination and a survey, after analyzing the complaints and behavior of a teenager. Bulging eyes, goiter and rapid pulse are a typical triad for DTG.

To confirm the diagnosis, additional methods research:

Ultrasound of the thyroid gland: determining the actual size of the gland, its structure, reducing echogenicity;
a blood test for hormones: thyrotoxicosis will confirm an increase in the level of T4 (thyroxine) and T3 (triiodothyronine), a decrease in TSH (thyroid-stimulating hormone);
thyroid scintigraphy, which determines the degree of capture of iodine by the gland, is unsafe for the child's body, therefore it is used in rare cases;
radioimmunoassay to determine the concentration of hormones and antibodies;
determination of basal metabolism - an auxiliary method for diagnosing thyrotoxicosis;
ECG registers heart rate, detects arrhythmias, signs of metabolic disorders in the myocardium;
biochemical blood test: to determine the protein, glucose level, liver enzyme activity, creatinine level, residual nitrogen, cholesterol, electrolytes and other indicators;
a blood test (general) can reveal a decrease in the number of blood cells during treatment with thyreostatics.

Treatment

Children with moderate and severe forms of DTG are treated in a hospital, and with mild form treatment can be done on an outpatient basis. Compliance bed rest recommended up to 3-4 weeks.

Conservative and surgical methods can be used in the treatment of DTG.

The main drug conservative therapy is Mercazolil or its analogues (Neomercasol, Metimbazol, Carbimazole, Tireozol). The drug has an inhibitory effect on the production of thyroid hormones. The dose and duration of the course are determined individually. A gradual decrease in the initial dose is carried out under the control of the pulse rate, body weight of a teenager, blood levels of T4 and T3, cholesterol levels. These data are taken into account and serve as criteria for the effectiveness of treatment.
Side effects of thyreostatics can be a decrease in blood leukocytes, platelets, anemia. With a decrease in leukocytes less than 2.5 * 10 9 / l, the drug is canceled and Pentoxyl, Leukogen, Metacil are prescribed, vitamin complexes. With a decrease in other blood cells, corticosteroids (Prednisolone) are prescribed.
Upon reaching the euthyroid state ( normal level in the blood of thyroid hormones) maintenance doses of Mercazolil are prescribed (the period of their intake - from 6 to 12 months - is also determined by the doctor).
The use of adrenergic blockers (Atenolol, Obzidan, Egilok, Kordanum, Anaprilin) can reduce the toxic effect of hormones on the heart and basal metabolism. These drugs are contraindicated in adolescents with bronchial asthma and chronic bronchitis. In this case blockers are used. calcium channels(Nifedipine, Verapamil).
From the 3rd week of treatment, small doses of thyroidin or triiodothyronine are prescribed to compensate for the deficiency of thyroid hormones while taking thyreostatics. Hormones are also canceled gradually as the euthyroid state is reached and the size of the thyroid gland decreases.
In the treatment of severe and moderate forms of thyrotoxicosis, Reserpine is used, which reduces arterial pressure, which reduces the heart rate, has a calming effect, normalizes sleep. Of the sedative drugs, Elenium, Seduxen, Trioxazin can be used for severe DTZ, and valerian for moderate form.
AT complex therapy includes the appointment of vitamin preparations (A, C, vitamins of group B), ATP, calcium preparations.

Ordinary iodine preparations are not used: firstly, they do not have an effect on DTG, and secondly, they contribute to the oncogenesis of the thyroid gland. In the USA, radioiodine is used in cases where thyreostatics have caused complications, when there is a relapse after surgery, when a teenager refuses to take pills.

In the Russian Federation, the use of radioiodine for the treatment of adolescents is prohibited due to possible complications(the risk of infertility in the future, the occurrence of gene inherited mutations, the development of leukemia or thyroid cancer). The United States believes that this risk is negligible.

Indications for surgical treatment are:

lack of effect from conservative treatment carried out for 6-12 months;
development of recurrence of DTG;
intolerance to thyreostatics;
goiter large sizes, retrosternally located, with nodes;
compression of the trachea, esophagus, recurrent nerve, vessels by goiter.

A subtotal resection of the thyroid gland is performed. The optimal age for surgery is after reaching 15 years.

To prevent bleeding during surgery and the development of a thyrotoxic crisis caused by excessive intake of thyroid hormones from the operating area into the blood for 10 days before surgical intervention a teenager is given Lugol's solution in milk (30 drops three times a day).

In the event of a crisis:

Lugol's solution with sodium iodide is injected intravenously (instead of potassium iodide to avoid the development of hyperkalemia) - in 1000 ml of 5% glucose solution 100-250 drops;
Mercazolil is introduced through the probe;
perform plasmophoresis (or hemodialysis, or hemosorption) to remove excess T4 and T3 hormones from the blood;
solutions of Reopoliglyukin, glucose, saline solution, Reosorbilact, Kontrykal are administered intravenously;
corticosteroids are injected into the vein (Prednisolone, Dexamethasone, Hydrocortisone);
according to indications, cardiac glycosides (Korglikon, Strofantin), caffeine, camphor are used;
with hyperthermia, an ice pack is used;
when excited, barbiturates, Chloral hydrate are prescribed;
feeding is carried out through a probe.

Treatment for thyrotoxic crisis is carried out for 7-10 days.

Diet

Dairy products must be present in the diet of a child suffering from DTG.

The diet for DTG depends on the severity of the disease. It should compensate for the increased energy costs of the body and correct metabolic disorders.

Indicative (unless the doctor prescribes a different diet) recommendations:

energy value on average should be 3600-3800 kcal;
carbohydrate content 500-570 g per day (about 150 g of sugar);
the amount of fat - up to 130 g (25% of them should be);
proteins - no more than 110 g (55% of them must be of animal origin, milk proteins are best).

The value of dairy products is also that they are rich (the need for it increases with DTG).

Of the vitamins, the most significant in thyrotoxicosis are B 1 (thiamine) and (retinol). This is due to the fact that B 1 promotes the conversion of glucose into fats and glycogen, and retinol reduces toxic effect thyroxine on the body, being to some extent its antagonist.

The source of these vitamins can be:

boiled meat or fish;
dairy;
vegetarian soups;
various cereals;
vegetables;
salads;
fruits and;
sunflower oil and butter.

Dishes and foods that have a stimulating effect on the central nervous system and heart should be excluded from the diet:

broths (fish, meat);
strong tea and;
chocolate;
spices and seasonings;
any alcoholic drinks.

You need to eat food 4 times a day. During conservative therapy with thyreostatics or when preparing a child for surgery, it is necessary to ensure the supply of a sufficient amount of iodine, which is rich in.

Exodus

The prognosis with proper treatment is favorable. Recovery occurs in 1-1.5 years. Carrying out thyreostatic therapy in 60-70% leads to stable remission. Early withdrawal of drugs leads to an exacerbation of thyrotoxicosis.

A relapse of the disease is possible 2 years after the achieved euthyroidism. In the case of an earlier return of DTG symptoms, it is regarded as undertreated thyrotoxicosis.

Clinical examination

After discharge from the hospital, a teenager is allowed to go to school after 1-1.5 months, is released from physical education lessons and physical activity. He is given an extra day off.

After the treatment of children, the endocrinologist observes monthly until recovery, and then quarterly. At each visit to the doctor, thermometry, pressure measurement, pulse counting, examination and measurement of neck volume are carried out.

Checked quarterly hormonal background(determination of the level of T3, T4 and TSH), as well as the content of sugar and cholesterol in the blood. Every 6 months, the teenager is consulted by a psychoneurologist, ENT, dentist, ophthalmologist.

The adolescent is deregistered after 3 years of the euthyroid state or 2 years after a successful operation. With DTZ Spa treatment contraindicated. With a euthyroid state, one can be treated in local sanatoriums in any season, and in the southern ones - from October to May.

Expertise questions

Adolescents with DTG are exempted from exams at school until they reach euthyroidism. With any form of thyrotoxicosis, children are exempted from physical education lessons. Simultaneous study and work are contraindicated.

Hard physical labor, night shifts, work with any kind of radiation (in a physiotherapy room, with an old monitor, in an X-ray room), in a smoky room are contraindicated for working teenagers.

Prevention

To prevent the development of DTG in children, the following are important:

observation of children with enlarged thyroid gland with its normal function;
general health measures, prevention of infections;
exclusion of stressful situations;
avoidance of excessive insolation.

This is especially important with the existing hereditary predisposition to thyrotoxicosis.

A thyrotoxic crisis can be prevented by strict conservative antithyroid treatment, excluding psychotraumas, and precise preparation for surgery (Lugol's solution).

Summary for parents

Thyrotoxicosis is a rather severe pathology of the thyroid gland, in which the functions of other organs change, metabolism is disturbed.

With late diagnosis of DTG, the development of severe complication- thyrotoxic crisis. With timely diagnosed thyrotoxicosis and properly administered therapy, the child may recover. However, with both conservative and surgical treatment, relapses are possible.

With subtotal removal of the gland, the development of hypothyroidism cannot be excluded, which requires the use of thyroid hormones throughout life.

Toddlers thyroid plays important role in the body. It is responsible for both mental and physical development. When there are malfunctions in the work of the secret, this negatively affects health. With complications of a complex type, manifestation of cretinism is possible.

Sometimes a teenager may have an enlarged thyroid gland. There are various reasons for this. What should parents do in this case if the child's thyroid enlargement causes negative symptoms?

About why the thyroid gland increases, what it can lead to if treatment is not started in time, as well as methods of prevention and treatment - all this will be discussed in the article.

If in a child this secret produces an insufficient amount of hormones or their increased concentration is observed, then this can adversely affect his general condition. Sometimes such a pathology at first is able to proceed without severe symptoms.

If such a disease is not detected in time and its treatment is not started, then in the future a person will have to take certain drugs throughout his life to maintain the hormonal background.

The main causes of an enlarged thyroid gland in adolescents are:

Bad ecology.
Lack of iodine in the body.
Stress.
Increased level of radiation.

It is possible to accurately determine the pathology in the organ only in a clinic during the passage complete examination and using modern equipment.

At the same time, it is important for parents to understand that when the first negative symptoms appear, you should immediately consult a doctor and not self-medicate.

The thyroid gland can produce these types of hormones:

thyroxin.
Triiodothyronine.
Calcitonin.

Enlargement of the thyroid gland in a child: causes

The main reasons that can provoke an increase in the thyroid gland in children include the following:

Inadequate intake of iodine. It is found in many foods, and therefore you need to eat properly and balanced.
Bad ecology.
Improper nutrition during gestation.
Heredity.

Organ diseases

At a young age, you can meet the manifestation of such ailments due to disruption of the thyroid gland:

Hypothyroidism.
Thyroiditis.
Hyperthyroidism.

If the thyroid gland in a child is enlarged, then it is important not to miss the moment of diagnosis and treatment for early stage pathology. This is the only way to avoid the manifestation of pathologies and complications that can negatively affect the mental and physical development baby.

Doctors say that even a slight decrease in the amount of hormones that this body, at a young age will lead to disruption of brain activity. Hormones also regulate metabolism, allowing you to turn food into energy, which is important for the functioning of the whole body.

Signs of pathology

Parents themselves can determine the presence of a diseased organ in a child. To do this, they only need to constantly monitor their child. You can determine the disease by the following signs:

The baby often gets sick, as his immune system is weakened, and the body cannot fight infections on its own. If there is not enough iodine in the body, then this negatively affects the elimination of bacteria.
The work of the myocardium is not rhythmic.
Swelling and lethargy.
Drowsiness and poor concentration.
The child is not growing well.
Anemia.
Constipation.
Temperature.
Bad dream.
Irritability.
Enlarged neck.

It is worth noting that usually the thyroid gland increases in children aged 3 to 12 years. Also, the pathology can be congenital. It is diagnosed immediately after birth. But this rarely happens, since a congenital ailment can manifest itself in one baby out of 30,000.

In a baby with an increase in the thyroid gland, various pathologies will be observed. He will not grow and gain the required weight for his age.

Diagnosis

Timely detected enlarged thyroid gland in adolescents makes it possible to avoid complications. Also, the start of treatment at an early stage guarantees successful disposal of the pathology in a short time.

Diagnosis begins with an examination. If the doctor detects deviations from the norm, then he prescribes additional examinations. This is usually a blood test to determine the amount of hormones in it. An ultrasound or biopsy may also be used.

Based on the data obtained, the doctor makes a conclusion, makes a diagnosis and prescribes therapy. Usually, treatment is carried out at home while taking various medications.

Early hypothyroidism

This disease can be acquired or congenital. If the pathology is fixed after birth, then the baby will not be able to develop mentally at the proper level. Often such a child is diagnosed with cretinism.

Symptoms:

Constipation.
Lethargy.
Jaundice.
Hoarseness.
Reduced temperature.

If treatment is started immediately with congenital pathology, then the prognosis will be positive. If the disease is started, then treatment can last a long time. Also, the baby may experience a crisis, which will lead to disturbances in the work of the myocardium and bone fragility.

Therapy tactics

When treating a disease, a child may be prescribed different tactics therapy. It all depends on the characteristics of the course of the disease and the child himself. Drugs are prescribed in each case individually. That's why standard methods there is no cure for this disease.

When the pathology passes with complications, an operation may be prescribed. After it, the child is credited with taking hormones to restore balance. Throughout the course of therapy, it is also important to follow a diet. The diet should contain foods with iodine.

Preventive actions

If the child belongs to the risk group, then he should visit a doctor for examination twice a year. At the same time, parents should also pay attention to the baby in order to determine the cause. frequent illnesses. You do not need to take a lot of antibiotics for ailments, as this can cause hypofunction of the organ.

You need to reconsider the diet of the baby. He will need products with a high content of iodine in the composition. Food should be rich in vitamins and minerals.

Conclusion

Based on the foregoing, we can conclude that an enlarged thyroid gland in a baby can cause serious complications and consequences if it is not treated on time. Sometimes, with untimely treatment, a child is diagnosed with cretinism.

Therefore, it is important for parents to constantly monitor their baby and changes in his health. When the first negative symptoms appear, you should immediately contact the clinic and do not treat yourself.

If the child eats right, then there is every chance that he will not get sick with such an ailment, if he is not of a congenital type. Knowing these points, everyone will be able to draw conclusions for themselves and, if necessary, make the right decision.

The thyroid gland is an organ without which the normal development of a child is impossible. The hormones it produces affect the formation of mental abilities, the functioning of the intestines, heart, blood formation, the maintenance of immunity, the desired body temperature and weight.

Respiratory and future reproductive function, sleep and the formation of the skeleton also depend on the functioning of this organ. If a child of any age has an enlarged thyroid gland, this leads to serious changes in his health. Consists of iron right lobe, which is always slightly larger than the left, and the isthmus. Located in front of the larynx. In children, it lies directly on the thyroid cartilage. The organ belongs to endocrine system person.

Why is the thyroid gland enlarged

Enlargement of the thyroid gland (TG) is a change in its size, mass, volume. Among the endocrine childhood diseases, it is thyroid dysfunction that occupies the first place. main reason- insufficient intake of iodine in the child's body during pregnancy and after birth. The period of intrauterine development and the first years of a child's life are considered the most dangerous. Prevention of iodine deficiency is put in the category of state tasks - 60% of the territory of Russia suffers from it.

The reasons for the growth of the thyroid gland are:

Lack of iodine - the thyroid gland enlarges to produce more hormones
Lack of systematic prevention of iodine deficiency in problem regions
Poor environmental conditions - children in industrial cities suffer greatly
Heredity
Malnutrition of the child and stress

In girls, the thyroid gland increases more often than in boys.

The degree of enlargement of the thyroid gland and its mass

Any growth of the thyroid gland is called a goiter. Probing the gland during the examination and evaluating it visually, the endocrinologist concludes about the degree of growth:

0 - no change in size is detected on palpation, the gland is healthy
I - there are no visual changes yet, but an increase is diagnosed on palpation
II - an enlarged thyroid gland is visually noticeable with the head tilted back
III - change in size is visible when the head is not tilted back
IV and V - the gland is very much enlarged and changes the contours of the neck

Normal thyroid mass in children of different ages

The maximum active thyroid gland becomes in children 5-7 years old and during puberty, as it is a powerful stress for a teenager. During this period, the thyroid gland increases especially strongly in girls.

Common Symptoms of an Overgrowth of the Thyroid

There are several diseases of the thyroid gland, in which its increase occurs. Each of them has its own characteristics. This highlights a series common symptoms, signaling problems in the children's body:

Body temperature becomes either high or low
Digestive disorders - constipation, flatulence, increased peristalsis, diarrhea
Sleep disturbances - the child sleeps little, becomes irritated. Sleep may take too long (up to 12 hours) with persistent lethargy
Weight fluctuations - as the thyroid gland regulates metabolic processes, then the child can either lose weight or gain a lot of weight
Shortness of breath, swelling
Visually noticeable growth of the thyroid gland in the later stages
School-age children lag behind in their studies, it can be difficult for them to concentrate on tasks

Signs of an enlarged thyroid gland are not immediately recognized and are often attributed to other diseases. If the child still has any changes, then it is necessary to contact an endocrinologist as soon as possible.

Childhood Thyroid Diseases

An increase in the thyroid gland in a child occurs due to a decrease or increase in hormone production, infectious diseases, injuries, and the presence of tumors. Children's thyroid diseases - hypothyroidism, hyperthyroidism, thyroiditis, Graves' disease, nodes and tumors.

Hypothyroidism

Manifested in a reduced production of hormones by the gland. With iodine deficiency, the size of the thyroid gland increases to compensate for their deficiency. Primary hypothyroidism is associated with disorders in the gland itself. It is congenital and acquired. If a child is born with reduced function SHCHZH, then he is diagnosed with cretinism. The disease is found in one child out of 4000, while girls are subject to it 2 times more often than boys. Secondary hypothyroidism occurs due to disorders in the pituitary gland or hypothalamus.

A child at any age becomes whiny, inactive, edematous, drowsy, depressive. There is an increase in weight, constipation appears, the skin turns pale, the hair grows dull and begins to break. Children under 6 years of age lose interest in games, learning simple things is difficult. Schoolchildren with hypothyroidism lag behind in school, sports, they are inhibited, uncommunicative, have bad memory. Puberty comes later, teenage girls have problems with the menstrual cycle.

hyperthyroidism

Observed increased secretion hormones. The disease is most often diagnosed in children from 3 to 12 years old. Congenital hyperthyroidism is present in only one child out of 30,000, while no gender dependence has been found. The disease occurs during pregnancy if the expectant mother suffers from Graves' disease.

In a newborn, hyperthyroidism is initially manifested by reduced weight and height, sometimes children are born prematurely. The baby is very mobile, excitable, he often has diarrhea, he sweats profusely, gains weight poorly. After some time, maternal hormones are independently excreted from the child's body, so these signs are most pronounced in the first weeks of a baby's life.

In children of preschool and school age with hyperthyroidism, there is accelerated exchange substances increased activity, sweating. Mood and weight are very unstable, sleep is poor, blood pressure is high. The child sleeps little, so over time it appears nervous exhaustion and increased fatigue. AT puberty girls get confused menstrual cycle. Perhaps the development of thyrotoxicosis - hormonal intoxication.

Thyroiditis

The first sign of the disease is a decrease in academic performance and a stop in physical growth. The remaining symptoms are characteristic of hyper- and hypofunction of the thyroid gland.

Basedow's disease

The same applies to autoimmune diseases. Adolescents 10-15 years old fall into the risk group, and girls get sick 8 times more often. Mood swings, fatigue, irritability are noted. Over time, the eyes bulge and the goiter grows, heart problems begin.

Nodes and tumors

An enlarged thyroid gland may contain areas of different texture or density. Their nature is good and malignant. A symptom may be difficulty in swallowing and the so-called "lump in the throat." All neoplasms are under constant control.

Diagnosis and treatment

The earlier an enlarged thyroid gland is detected, the more successful its treatment will be. If the necessary measures are not taken, the disease can lead to severe consequences.

Diagnosis of changes in the thyroid gland consists in examining the child by an endocrinologist, collecting information and complaints from parents, palpation of the gland. Tests are prescribed for hormone levels (TSH), the amount of iodine in the blood, ultrasound, MRI, and, if necessary, a biopsy is done. The generalized data make it possible to determine the cause of the change in the shape, mass and volume of the thyroid gland, as well as the degree of increase. For newborns, it is planned to detect hypothyroidism in the maternity hospital, because the level of development of the child depends on how quickly hormonal hypofunction is detected. By recognizing the disease before the age of 1 month, the child can be provided with normal mental and physical development.

Primary importance in the treatment is given to drugs with iodine. The dose and regimen of administration is determined only by the doctor based on the information collected and the tests performed. The following methods are used:

Hypothyroidism - drugs are prescribed that raise the level of hormones to the required level
Hyperthyroidism - drugs are prescribed that suppress the activity of the thyroid gland. Congenital hyperfunction of the thyroid gland due to disease future mother during pregnancy, is not treated. Maternal hormones simply leave the body of the newborn or their activity is suppressed by temporary medication
Graves' disease - a mild form is treated at home, with moderate and severe the child is hospitalized
With a strong increase in the thyroid gland, it is possible to remove part of it

Enlargement of the thyroid gland in children is much less common than in adults. Unfortunately, disorders in this organ in a child are much more dangerous, since a lack or excess of thyroid hormones synthesized by the gland leads to developmental delays. Of course, timely diagnosis and therapeutic measures may well prevent such consequences.

The thyroid gland in children is involved in the formation and growth of the skeleton, supporting the work of the brain, regulating metabolism and normalizing body weight. All this is provided by thyroid hormones, which include thyroxine and triiodothyronine.

Features of the development of goiter in childhood

A child's body, in comparison with an adult, constantly needs various substances: vitamins, minerals, amino acids. The need for iodine at this age is very high, as it is a stimulant for the synthesis of thyroid hormones. If the child for a long time this element is not enough, a goiter is gradually formed, i.e.
an enlargement of the gland occurs.

Goiter can be both with preserved organ function and with impaired production of thyroid hormones. With a reduced production of these substances, a hypothyroid form of goiter develops, with an increased production - thyrotoxicosis. An increase in thyroid tissue can occur due to the development of Graves' disease or inflammatory processes. Much less often, this organ increases due to a malignant disease or the appearance of tumors.

Goiter is classified by degree, with normal ranges of thyroid volume in children depending on the number of years and gender. So, in a child of six years, the norm is considered to be 5.4 cm cube in boys, 4.8 cm cube in girls. The value increases as it grows. Goiter is an endemic pathology, and the disease is more common in regions with iodine deficiency. That is why it is necessary to carry out the prevention of this phenomenon in children.

Types of thyroid enlargement

Goiter in children is divided into the following forms:

In some cases, an enlarged thyroid gland in a child may be the result of thyroiditis, which in turn is divided into acute, subacute and chronic form. Congenital goiter is diagnosed much less often in children. The detection of pathology occurs at an early age, and more often an increase in this organ is found in girls. The reasons for the development of the disease are:

poor nutrition during pregnancy;
infections during gestation;
the action of harmful substances;
an increase in the thyroid gland in a pregnant woman;
pathology of the pituitary or hypothalamus in a child;

Enlargement of the gland can also occur due to the appearance of nodular formations in it. This pathology is called "diffuse-nodular goiter."

Euthyroid goiter

The most common form of thyroid enlargement is precisely euthyroid, in which there are no deviations from normal values.
This condition is considered less dangerous for the child. More negative effect elevated levels thyroxine and triiodothyronine, since an excess of these hormones causes poisoning. In the case of the development of a euthyroid state, such intoxication does not occur.

The most common cause of euthyroid goiter in children is iodine deficiency. Girls are most susceptible to an increase in thyroid tissue, and this happens due to hormonal changes during puberty. Also, the factors contributing to the development of goiter include foci of infections, stress, genetic predisposition.

In addition to the enlargement of the thyroid gland itself, children experience symptoms such as squeezing the esophagus, problems with swallowing, and shortness of breath. Compression occurs already at an extreme degree of growth of the tissues of the organ.

Signs of toxic goiter in children

If the child's thyroid gland works too intensively, this leads to an increase in all reactions and processes in the body, which leads to metabolic disorders. With the synthesis of an excessive amount of thyroid hormones in children, weight loss occurs. Growth retardation, hyperthermia, sweating, nervousness, nausea, increased diuresis are also observed. Externally, the disease is manifested by protrusion of the eyeballs. Also, children have increased appetite, there are frequent diarrhea and thirst.

Toxic goiter can also occur due to inflammatory process. This condition is called Hashimoto's disease, which is more common in children over the age of four. In babies aged two or three years, this disease occurs extremely rarely. It is a consequence of an immune failure in the body, in which antibodies begin to be produced in it that damage the gland itself. And if at first there are signs of thyrotoxicosis, then in the future pathological process leads to atrophy of the tissues of the organ and a decrease in its functions.

Diagnostic Measures

Congenital goiter in newborns is more often detected in the first weeks. At the moment, all babies in maternity hospitals undergo a study of the functions of the gland. With timely therapeutic measures taken, it is possible to completely restore the deficiency of thyroid hormones and avoid such possible consequences like developmental delay and cretinism.

In children from two years of age and older, an examination and palpation of the thyroid are performed during the examination. The specialist also interviews the parents and the child. If there is a suspicion of goiter development, the doctor prescribes a blood test for thyroid hormones. The thyrotropin index is also important for the diagnosis. This hormone is synthesized by the pituitary gland and has a direct connection with thyroid receptors.

Often, the doctor prescribes a blood test and for antibodies to the gland, as well as an ultrasound. If nodes are detected in the tissues of the thyroid gland using ultrasound, the specialist recommends undergoing a fine-needle biopsy, which is necessary to determine the nature of the formations and prescribe further therapeutic measures.

Treatment of goiter in children

With reduced thyroid function, they are prescribed hormonal agents containing an analogue of thyroxin. The dose is selected depending on the number of years of the child and the surface area of the body.
Usually, small doses are given first, and then reanalysis for hormones.

With euthyroid goiter in a child, synthetic thyroxine therapy is usually not carried out, but iodine-containing drugs ("Jodomarin") are prescribed. Treatment must be supervised by a specialist. Also, an endocrinologist may recommend strengthening nutrition with foods that contain a lot of iodine and other important substances. It is useful for children to use seaweed, fish and seafood, vegetables, fruits, honey. It is advisable to remove pastries, fatty meat, sweets from the diet - all this contributes to inhibition of the production of thyroid hormones.

If a child is diagnosed with hyperthyroidism, then the doctor may prescribe drugs that reduce the synthesis of thyroxine and triiodothyronine. They are also prescribed depending on how old the child is. In thyrotoxicosis, on the contrary, products with iodine should be excluded, as well as the caloric content of the diet should be increased, since the metabolism in this disease is very high, and the child usually suffers from underweight.

Treatment for thyroid disease must be carried out without fail, since even a slight increase in this organ leads to
psycho-emotional problems and stunting. Children with hypothyroidism are often closed, have problems in communication, and study poorly. Memory and attention also suffer. Medical measures, taken in a timely manner, eliminate all these problems.

Improper therapy or its absence in newborns with congenital goiter leads to cretinism, manifested by short stature, enlarged head, short limbs, mental retardation and weak immunity. Therapy in such children is only supportive and makes them feel a little better. The earlier an enlarged gland is detected in infants, the greater the chance of avoiding developmental delay.

Prevention of goiter in children

Prevention of thyroid pathologies should be dealt with already during pregnancy, since any deviations in this organ in the mother can lead to abnormalities in the development of the thyroid gland in the fetus.
During pregnancy, it is necessary to avoid and treat all infectious diseases. Also, already in the first weeks, it is advisable to undergo an examination by an endocrinologist and, if the thyroid is enlarged, thyroxine and iodine preparations should be taken, the dosages of which are prescribed strictly by a specialist.

The disease of this organ in children can be prevented by a quality diet containing iodine. A good prevention is the use of iodized salt. At any age, children need to walk longer on fresh air while avoiding direct sunlight. It is also desirable to avoid uncontrolled use of drugs antibacterial action. All children are shown moderate physical activity. You also need to remember about water regime. A three-year-old baby should drink from 1 to 1.5 liters clean water. At a younger age, the rate is calculated at the rate of 50 ml per 1 kg of the baby's weight. Lack of fluid leads to various violations in the body, including thyroid diseases.

Thyroid diseases in adolescents often go unnoticed, and the problem becomes noticeable when the disease moves to a more dangerous stage.

An annual dispensary examination by an endocrinologist helps to detect pathology at the very beginning of development and start treatment on time.

The thyroid gland is a miniature organ located in the neck, the weight of which is healthy condition barely reaches 30.

Throughout a person's life, it controls the metabolic processes in the body, the activity of tissues and organs.

The quality of the thyroid gland depends on a sufficient amount of iodine, which the body receives from food and water. For its work, iron uses about a third of the total amount of iodine contained in the body.

If the thyroid gland is enlarged in a teenager, this primarily indicates an iodine deficiency.

Features of the thyroid gland in adolescence

Adolescence, accompanied by the process of puberty, begins at about 11–12 years of age.

The thyroid gland in adolescents begins to work with increased activity in order to provide hormones to the growing body. At this time, the thyroid gland may also undergo external changes.

Important: Enlargement of the thyroid gland in adolescents is a fairly common occurrence. This is due to iodine starvation, when the body cannot provide for the increased functional needs of the gland.

Common symptoms of thyroid disease

Enlargement of the thyroid gland in adolescents does not occur from the first day of the disease. This process may be preceded by a long period.

Thyroid gland in adolescents

If the thyroid gland does not cope well with its duties, the symptoms in a teenager are of the following nature:

early sexual development or its delay;
growth retardation;
dry skin;
swelling;
hair loss;
discomfort and pain in the front of the neck;
cardiopalmus;
frequent constipation or diarrhea;
decrease in concentration;
nervous conditions;
sleep disorders;
weight fluctuations.

Laboratory studies for thyroid diseases

It happens that the thyroid gland in a teenager is slightly enlarged, and it can be difficult to detect pathology.

Important! Symptoms cannot serve as the only confirmation of the disease.

To make an accurate diagnosis of thyroid disease in adolescents, an extended examination is carried out.

Laboratory methods

total triiodothyronine (T3);
free triiodothyronine (T4);
total thyroxine;
free thyroxine;
blood for thyroid-stimulating hormone (TSH);
antibodies to thyroglobulin (TG);
x-ray;
laryngoscopy.

Instrumental Methods

To diagnose thyroid disease in adolescents, only some types of examinations are required, which are prescribed

after external examination and palpation of the gland.

Why is the thyroid gland enlarged in a teenager if the hormonal background is not disturbed? It turns out that the problem is the lack of iodine.

Thus, a protective reaction of the body to the deficiency of an important trace element is manifested.

Thyroid disease in adolescence

The thyroid gland in adolescence must produce a certain amount of hormones. Their deficiency or excess leads to the following diseases(code according to ICD-10 / E00-E07):

Low functionality of the thyroid gland, which is accompanied.

The reason may be congenital pathology, iodine deficiency states, traumatic injuries of the gland, autoimmune diseases.

Symptoms:

blood pressure disorders
weight gain,
weakness,
dry skin,
brittle nails,
hair loss,
frequent nasal congestion.

This disease () is diagnosed if thyroid hormones in adolescents are produced in excess. The disease has three stages of severity, depending on which symptoms appear.

The following signs indicate that the thyroid gland in adolescents produces an excessive amount of hormones:

increased irritability, excitability;
rapid pulse, heart failure;
loss of appetite;
fast fatiguability;
muscle weakness;
deterioration in the condition of nails, hair, skin.

Prevention and treatment of thyroid diseases

The thyroid gland in adolescence most often lacks iodine, so prevention is aimed at replenishing it.

A specialist can prescribe special dietary supplements and, but the easiest way out is to replace ordinary salt with iodized salt, and: seaweed, fish, shrimp, boiled eggs, baked potatoes, cranberries, prunes.

In order for the thyroid gland to adolescence was provided with the necessary amount of iodine, its daily dose should be 100 mcg per day.

If it is visually clearly visible that the thyroid gland in a teenager is enlarged, what should be done in this case?

Since the symptoms of insufficiency and excess production of hormones look about the same, it is not recommended to try to resolve the issue with iodine-containing drugs and products before taking and consulting a specialist.

Thyroid treatment in adolescents depends on the severity of the disease and the results of the examination.

It is aimed at restoring the functionality of the gland by taking drugs with iodine, hormone therapy. Teenagers respond very well to treatment.