Inflammation of the thyroid gland in children symptoms. Thyroid diseases in children and their impact on the body

Thyroid is a gland internal secretion that synthesizes the hormones thyroxine, triiodothyronine, calcitonin. These hormones play a huge role in regulating the development of the body and the metabolism of the child. Thyroid disorders in children require special attention. The child's body grows and develops, and even minor deviations in homeostasis can lead to serious problems.

Thyroid diseases have various causes and manifestations, but, unequivocally, deviations in its work negatively affect the baby’s health that has not yet been strengthened. Any problems require immediate and systematic treatment under the strict supervision of an endocrinologist and taking into account all contraindications. Consider the most common thyroid diseases in children.

Hypothyroidism

Hypothyroidism is a deficiency of the thyroid hormone, thyroxine. It can be either primary or secondary.

The primary form is due to defects in the thyroid gland itself and can be congenital (cretinism) and acquired.

Congenital diseases include: hypoplasia - underdevelopment of the gland, aplasia - its complete absence, as a result of intrauterine abnormal development, a defect in the structure and functioning of hormones (often inherited factor), thyroid disease or iodine deficiency in the mother's body during pregnancy.

Factors in the development of acquired hypothyroidism can be: iodine deficiency in the body, difficulty in the absorption of iodine due to the peculiarities of the diet, inflammatory diseases thyroid gland, metabolic disorders, surgery, radiation exposure. Acquired hypothyroidism is often accompanied by diseases of other endocrine glands (polyendocrine insufficiency) or autoimmune processes.

Secondary hypothyroidism - develops when the regulatory function of the pituitary or hypothalamus is impaired. These glands, located in the thickness of the brain, secrete thyroid-stimulating hormone, thereby controlling the synthesis of hormones. The initiating factors for the development of the problem are: perinatal trauma, meningitis, encephalitis, trauma and brain tumors.

Hypothyroidism is manifested by the following symptoms:

low body temperature;
hypotension;
drowsiness, fatigue, depressed emotional state;
constipation, biliary dyskinesia;
bradycardia;
reduced level of reflexes;
dryness skin, deterioration of hair and nails;
weak muscle tone;
swelling of the face and limbs;
metabolic disorders, obesity;
late teething in infants;
decreased brain activity and intellectual abilities;
body disproportion, short stature (as a result of a violation of the synthesis of calcitonin), etc.

Congenital thyroid hormone deficiency affects girls twice as often as boys. Thyroid disorders in infancy lead to the development of cretinism. Cretinism is characterized by a low rate of growth and maturation of the child's body, brain damage. May develop psychical deviations, deaf-mute. In a neglected state, cretinism can lead to the development of oligophrenia - a persistent and irreversible mental retardation.

The severity of symptoms and consequences depends on the age at which the pathology arose and how soon the treatment of the sick child began. If from the first days of life the baby is supported by hormone replacement therapy and other drugs, then the risk of irreversible abnormalities is significantly reduced. In cases where treatment is ignored, the disease takes on a severe form and often leads to lethal outcome.

Therapy is aimed at eliminating or neutralizing the cause. Depending on the factor that caused the violation, preparations of thyroxin and other hormones, potassium iodide and vitamin complexes are prescribed, physiotherapy exercises, adherence to a special diet are recommended, in some cases corrective pedagogical measures are required.

hyperthyroidism

Hyperthyroidism (thyrotoxicosis) is characterized by excessive activity of the thyroid gland and a high level of thyroxine in the blood of the child. The problem may be associated with hyperfunction of thyroid cells, metabolic disorders, and also develop against the background of excess content iodine in the body or intake hormonal drugs. Most often, children aged 3 to 12 are ill. With this pathology, the following symptoms are observed:

tachycardia;
hypertension;
increased body temperature;
irritability, irritability, aggression;
disorders of the brain;
sleep disturbances, increased fatigue;
metabolic disorders, weight loss;
exophthalmos (protrusion of the eyeballs);
skin pigmentation;
frequent urination, systematic diarrhea;
violation of the menstrual cycle;
tremor, nervous tick etc.

Hyperthyroidism is autonomous and associated with dysfunction of the pituitary gland. An autonomous form is caused by tumors and neoplasms in the gland tissue different nature(Albright's syndrome) and autoimmune diseases (Graves' disease). The pituitary gland, in turn, regulates the functioning of the thyroid gland through the synthesis of thyroid-stimulating hormone.

There are rare cases of neonatal hyperthyroidism. Usually, the disease is a consequence of hyperfunction of the thyroid gland in the mother during the gestation period. Antibodies that stimulate the production of thyroid hormones enter the bloodstream of the fetus from the mother's body. The level of antibodies is determined through a blood test. Usually, the baby's condition stabilizes without serious medical intervention a few months after birth.

Traditionally, the treatment of the disease is aimed at eliminating the cause of the development of the disease. Depending on the factor that provoked the development pathological condition, the doctor prescribes to the child blockers of receptors complementary to thyroid hormones, drugs that reduce thyroid secretion or suppress the synthesis of thyroid-stimulating hormones by the pituitary gland. Therapy is supported by maintenance active image life and adherence to a special diet.

Thyroiditis

Thyroiditis is inflammation of the tissues of the thyroid gland. different nature. Depending on the factors that caused inflammation, there are the following forms pathologies:

specific (caused by an infection of a certain kind);
non-specific (when the pathogen is not identified);
acute (purulent and non-purulent);
subacute (viral).

Thyroiditis is characterized by the appearance of pain in the thyroid gland, a change in voice, general weakness. The thyroid gland increases in size, there is an increase in body temperature, cervical The lymph nodes, the pain becomes pronounced, and intensifies with movements of the neck, when swallowing and when touched. A blood test shows an excess of white blood cells. As for the secretory function of the thyroid gland, at the first stage there is an excessive secretion of hormones, which then turns into hypothyroidism. In some cases, there are purulent formations, abscesses in the tissue of the organ.

The acute form requires a fairly long-term treatment, the patient is prescribed strict bed rest, a course of antibiotics, general tonic and symptomatic therapy. If secretion disorders are noted, the doctor prescribes drugs to the child to stabilize the balance of hormones. With the development purulent inflammation biopsy and surgery are recommended.

The subacute form is accompanied by the formation of granulomas - formations from giant cells. They are formed as a result of the destructive effect of antibodies on thyroid cells. With this disease, symptoms characteristic of acute inflammation are noted.

For treatment, glucocorticosteroids and drugs based on salicylic acid and pyrazolone. Preparations to stabilize the hormonal background are usually not prescribed in this case.

Autoimmune thyroid disease

The mechanism of autoimmune diseases lies in the fact that as a result of immune failures, specific antibodies are released, which take the cells of their own body for a foreign body and destroy them. Often these conditions are due to hereditary factors and provoked by infectious diseases. Surveys show that usually autoimmune processes are not limited to only one organ, but spread to their entire systems.

It may be required for children at any age, but girls suffer from this disease several times more often than boys. The thyroid gland increases, a goiter is formed, in the first stages, symptoms of hyperthyroidism are noted, then the secretion of the gland decreases. Often the disease is the result of a polyendocrine autoimmune syndrome. Treatment is symptomatic, i.e. they use drugs to stabilize the hormonal background, anti-inflammatory drugs, sometimes surgery is required.

Basedow's disease (Graves' disease) or diffuse toxic goiter often affects adolescents, and girls are more susceptible to the disease than boys. Ultrasound shows diffuse, i.e. uniform, enlargement of the thyroid gland. The analysis revealed hyperthyroidism.

The disease is characterized by thyrotoxic crises. They can be caused by stress, infections, operations, etc. The crisis is serious condition organism, which is accompanied by serious disorders of the cardiovascular and nervous system. In severe cases, a crisis can lead to coma and death.

Treatment of thyroid disease involves taking substances that suppress the secretory activity of the thyroid gland, hormone replacement therapy is carried out. The doctor also prescribes symptomatic treatment, taking vitamins and diet.

Neoplasms in the tissues of the thyroid gland

Riedel's goiter (Chronic fibrous thyroiditis). This disease is characterized by the growth of the connective tissue of the thyroid gland and the formation of fibrosis. General state the health of the child and the level of hormones does not change, but with a significant increase in compaction, symptoms associated with compression of the trachea, esophagus, larynx may be noted: the voice changes, difficulty breathing occurs, coughing, swallowing is disturbed, especially solid food. For diagnosis, palpation examination and ultrasound are sufficient. This condition can only be treated surgically, removing part of the thyroid gland.

The thyroid gland in children is the main organ humoral regulation, responsible for the formation of the whole organism, in particular, the mental and psychological spheres. At the time of its malfunctioning, many severe pathologies develop, including a lag in the physical and mental development, which develops into serious disease- cretinism. Thyroid disease can be completely cured with early stages, in this case there will be no irreversible changes and the disease will be stopped.

The influence of the endocrine organ on the growth of the child

The productivity of the functions of many organs depends on the work of the thyroid gland: the heart, intestines, kidneys and others. The hormone produced by the gland plays a leading role in the process of growth and development of the child's body. Under the influence of thyroidin, musculoskeletal system, reproductive organs, nervous and respiratory system. Brain functions, sleep patterns, and behavioral processes depend on the balance of hormones.

If the thyroid gland increases, this leads to health problems at any age, starting from the earliest. Thyroid diseases in children develop under the influence of a number of factors.

Causes of diseases

With the development pathological process there is a change in the size of the organ, its mass and tissue composition. Thyroid diseases in children rank first among hormonal disorders.

The main reason for the defective work of the gland is iodine deficiency in fetal development. The critical period is the moment of laying the humoral system in the fetus. If during this period the mother had a lack of trace elements, the child needs clinical observation both immediately after birth and several years after it.

The underlying factors for changes in organ tissue are:

Frequent stress, overwork of the nervous system
Living in ecologically unfavorable areas, near large industrial enterprises
Iodine deficiency in water and soil leads to endemic goiter - the disease is common in some high mountain regions and requires mass prevention among the population
hereditary predisposition
Improper nutrition

Due to a lack of iodine, the thyroid gland increases in size and mass, trying to compensate for the resulting hormonal deficiency. This happens more often in girls, in male children the problem is less common.

What diseases can develop?

Major thyroid disorders in young children:

Hyperthyroidism - increased activity of the thyroid gland;
Hypothyroidism - insufficiency of the thyroid gland with a drop in hormone production;
Inflammation of the gland, called thyroiditis;
nodular goiter;
Tumors arising from hormone-producing tissue;
Hypoplasia of the gland and degradation of its tissues.

To clarify the diagnosis, it is necessary to perform a number of diagnostic procedures:

Donate blood for hormones and antibodies: antiroglobulin and antiperoxidase
Get an ultrasound exam

If a malignant tumor is suspected, additional research methods are used: scanning with radioisotopes, a biopsy of the gland tissue with its subsequent study.

The degree of increase in the mass and volume of the thyroid gland

Diagnosis of the thyroid gland in children includes determining the degree of tissue growth and changes in their mass. The growth of goiter from the tissues of the thyroid gland is divided into degrees depending on the severity of the changes.

Mass gland for children different ages presented in the table below.

Age	Average weight, g
Newborn	1,5
1 month	1,4
6 months	2,0
1 year	2,6
2 years	3,9
4 years	5,3
10 years	9,6
14-18 years old	14,2

What thyroid diseases are common in childhood

Due to the lack of iodine in food and the deterioration of the ecological climate, thyroid diseases among children are now becoming more common.

Iodine plays the role of the main trace element necessary for the synthesis of thyroid hormones, its deficiency leads to developmental disorders. With a lack of iodine in a woman during the period of bearing a child, premature birth, spontaneous abortion, or severe deformities may develop.

Symptoms of thyroid disease in children depend on the cause of the disease. Most often, the same pathologies that occur in adulthood develop:

Hypothyroidism occurs in one out of four thousand newborns, and in girls the percentage of cases is twice as high as in boys. The cause of the disease is the underdevelopment of the gland tissue and its functional failure. As a result, a lack of thyroid hormones develops, which affects the functioning of all organs and systems, the brain is especially susceptible to pathological changes. Disturbances in the intellectual development of the child can be stopped if the therapy for congenital hypothyroidism was started immediately, if the disease is on initial stage could not be identified, the prognosis will be unfavorable.
Hyperthyroidism is a pathology of the thyroid gland, in which an excess of hormones occurs, leads to an acceleration of metabolism and loss of muscle mass. In addition, tachycardia, shortness of breath, arterial hypertension. Sweating increases, there is a tremor of the limbs, a nervous tic. Behavioral disorders include anxiety, tearfulness, irritability, and insomnia.
Hashimoto's thyroiditis occurs under the influence of an autoimmune conflict, as a result of which the body's immune cells begin to attack the cells of the gland. The growth of the child and its development slow down, and a characteristic goiter occurs. With this type of disease in history, there are: decreased performance, chronic fatigue, dry skin, drowsiness, lethargy, spontaneous weight gain. Treatment for patients with Hashimoto's thyroiditis hormonal drugs for life - this will help reduce the severity of symptoms and improve the quality of life.

In cases where the disease is caused by an excess of the hormone, part of the thyroid gland is removed to normalize metabolism.

endemic goiter

In regions where iodine is constantly lacking in water and food, children develop endemic goiter, which manifests itself in various disorders:

feeling weak
higher fatigue. than a healthy child
discomfort, chest tightness
frequent lingering headaches that become permanent over time

Disorders in the work of the cardiovascular and nervous systems also develop.

During chronic iodine deficiency, the thyroid gland slowly grows, squeezing the trachea and blood vessels. The child complains of a "lump in the throat", and the discomfort is aggravated in the prone position. There is difficulty swallowing, a feeling of suffocation and a dry cough. If the pathology grows excessively, asphyxia of the patient is possible.

nodular goiter

The nodular goiter is benign neoplasms in the tissues of the thyroid gland and in children is observed in extremely rare cases. Nodular goiter means:

lymphocytic inflammation of gland tissues
benign glandular tumor
pathological location normal tissue body
thyroid duct cyst
cystic lesion of one of the lobes of the thyroid gland with hypertrophy of neighboring lobes
abscess

In most cases, the disease does not manifest itself in any way and becomes noticeable only when the nodes reach large sizes and are visible through the skin. Most often there is a compaction of the anterior part of the goiter. Often neoplasms have an irregular or asymmetric shape.

If the disease progresses, then symptoms appear caused by mechanical compression of the organs located in the neck:

Due to compression of the trachea and larynx, a feeling arises foreign body in the throat
hoarseness of voice, as in colds
asthma attacks, difficulty breathing, frequent seizures agonizing dry cough

A child with this pathology has difficulty swallowing, as the nodes press on the walls of the esophagus. The blood supply to the brain worsens, tinnitus, dizziness occur, fainting may develop.

Pain in the goiter appears if the nodes begin to grow rapidly, there is also a risk of internal bleeding.

Diagnosis and treatment

The disease is most easily treated early stage If the disease is started, irreversible changes may occur, and the complications that have begun will entail a risk to the health of the child, his development and life.

Diagnostics is carried out in stages:

The doctor conducts an examination, collects an anamnesis, interviews parents, analyzes the results;
Tests are prescribed for the level of thyroid-stimulating hormones, their activity;
Biochemical analysis reveals the lack of iodine in the body;
Are used instrumental research: ultrasonography of the thyroid gland, magnetic resonance or computed tomography, if necessary, a biopsy of the tissues of the gland is performed and their study at the cellular level

Data analysis allows to determine not only the degree of change in the mass, shape and volume of the organ, but also to find out the cause of the development of the pathology. The modern health care program provides for the detection of thyroid pathology in newborns directly in the maternity hospital in order to avoid mental and physical abnormalities at an early stage of the disease. If therapy is started from the first days of life, the child has a chance to normal development and the formation of intelligence.

The therapy is based on compensation for iodine deficiency, iodine-containing drugs are prescribed and biological additives. The dosage of drugs, their combination and duration of therapy is determined by the attending physician based on the examination data. Self-medication or self-cancellation of drugs is prohibited!

With hypothyroidism, drugs are prescribed that stimulate the production of hormones or drugs that perform a substitution function

In the period of hyperthyroidism, agents are indicated that reduce the activity of the gland and eliminate excess hormones. Congenital hyperactivity of the thyroid gland is not subject to treatment: hormones obtained from the mother's blood leave the body on their own, in severe cases they can be removed with medication

Basedova lung disease And medium degree severity is treated at home, under the supervision of a doctor, with severe forms sick child is sent to the hospital

If conservative treatment fails and the gland continues to increase, surgical intervention is indicated with excision of the enlarged part of the organ.

Summary for parents

In order to obtain a complete clinical picture and a detailed treatment plan for thyroid dysfunction, contact your local pediatrician. The therapist will refer you to a specialist endocrine disorders in children who will prescribe qualified treatment based on complaints and examinations.

Thyroid diseases can be prevented by including iodine-containing foods and vitamins in the child's diet. With a lack of iodine in water and food, a specialist prescribes medicines containing iodine for preventive purposes - this greatly reduces the risk of diseases of both the thyroid and other types of glands.

You should not give such drugs on your own, as it is easy to exceed required dose iodine in the body, which can lead to the appearance various violations thyroid gland, provoke hyperthyroidism and various pathologies from the hormonal system.

The thyroid gland in children is responsible for the physical, mental development of the body.

If there is a violation of the work of at least one function, it will certainly affect health.

In such a situation, manifestations of severe ailments, delayed physical and mental development, for example, cretinism, are possible.

To understand how the thyroid gland works in children, blood tests are performed immediately after birth.

With insufficient production of hormones, special external signs of such a situation will not be noticeable until a certain time. Only in more adulthood lifetime use required replacement therapy.

The deterioration of the environment, insufficient intake of iodine with food are the main reasons for the increase in the number of diseases.

Refined foods, synthetic carbonated drinks that everyone likes so much, do not contain iodine. Its deficiency can lead to unpredictable consequences.

The gland produces three main hormones:

triiodothyronine;
thyroxine;
Calcitonin is involved in the formation of bones, the metabolic process of calcium depends on it.

Hormones, the first on the list, take an active part in the maturation of the body, its growth, regulate metabolic processes.

For the production of thyroid hormones, iodine and tyrosine (an amino acid) are constantly required. Iodine deficiency leads to a decrease in intelligence, knots are possible. The younger generation, which does not receive enough iodine with food, is characterized by slow physical and mental development.

The increased level of radiation affects the work of the gland. Especially among residents living in areas of high radioactivity. It is in them that neoplasms on the organ are more often detected.

Stress is another reason that can provoke thyroid disease in children. During stressful situations, some hormones are produced in large quantities than you need, others are not enough. There is an imbalance of work, as a result, signs of the disease appear.

What size of the thyroid gland in children is determined by ultrasound. The volumes of this organ in boys and girls of the same age are different. In order to detect an illness of the initial stage, it is very important to conduct a study. These studies will help determine the level of hormones, understand the pathology of the disease. All studies help to accurately determine the degree of damage to the organ for appointment the right treatment.

The most important thing that parents should know: when a malfunction of the thyroid gland is detected immediately, at the very initial stage they began to treat it, then it will definitely be favorable outcome. You should only be observed, entrust the treatment to an experienced endocrinologist.

Types of ailments that occur at a young age:

hyperthyroidism;
hypothyroidism;
diffuse goiter;
thyroiditis.

If you miss the moment of identifying thyroid ailments of the young generation, you can miss the treatment of an early stage, then it is possible big problems health, physical and mental development. Only a slight decrease in the function of the thyroid organ leads to a decrease in intelligence, the baby lags behind in mental development. The hormones triiodothyronine and thyroxine are responsible for metabolic processes. Scientists have confirmed that each disease depends on the unstable state of the endocrine organ.

External signs giving a reason to see a doctor:

Children at risk, that is, often ill, who have a reduced function of the immune system. With the development of hyperfunction, the ability of the immune system decreases, so it is difficult for the body to cope with viral and bacterial pathogens. It has been established that iodine is involved in many immune reactions. With insufficient consumption of iodine-containing products, the activity of neutrophils and macrophages decreases, which must neutralize viruses and bacteria.
When there is an irregular heartbeat of the baby.
By the appearance of the baby, you can understand that there may be problems associated with the endocrine organ. The physical condition may be lethargic, the skin is dry, and puffiness may appear.
Schoolchildren are haunted by drowsiness, inattention, difficulty concentrating. Such signs often indicate a loss of interest in learning, but they also indicate possible development ailment.
When the growth of a child lags behind peers. The rate of increase in growth per year is approximately 4 cm.
If anemia is present and iron-containing preparations there is no expected result, this is an occasion to check the condition of the thyroid gland.
Frequent constipation.
Increased radiation background.

Prevention

For prevention, if the baby is at risk, you need to visit an endocrinologist every six months. Parents need to be patient, and sometimes persistent, to identify real reason frequent infectious diseases. By the way, excessive consumption Antibiotics can cause hypothyroidism.

The diet should contain foods containing iodine. In order to drink less pills in the future, it is better to eat food rich in vitamins and minerals.

Food should be varied. Various vitamins are important for the normal growth of the body. There are no essential and minor vitamins. For example, iodine does not require a lot, daily dose is approximately 150–300 mg, but if the body does not receive its norm, then health will not be stable. It is much easier to engage in preventive measures than treatment.

Care must be taken when parents are in alcohol addiction.

Enlargement of the thyroid gland in children is diagnosed in the period of 3 years to 12 years. A congenital ailment is observed in only one patient per 30,000 births. The disease is transmitted from a woman in labor if she suffered during pregnancy Graves' disease.

An infant suffering from hyperthyroidism initially does not gain the desired weight and lags behind in growth development, sometimes they are born prematurely. The baby is easily excitable, very mobile, suffers from diarrhea, profuse sweating, gains little weight. Mother's hormones after time are removed without intervention from the baby's body. That's why bright signs appear only in the first few weeks of his life.

The disease is recognized by general symptoms, according to which problems with the gland are fixed.

The temperature changes frequently.
The presence of diarrhea or constipation, that is, problems with digestion.
Digestive problems can be the cause of weight fluctuations.
Sleep problems.
Irritability, lethargy are the results bad sleep.
The student has difficulty concentrating.
The volume of the neck increases already in the later stages.

In adolescents with hyperthyroidism, the metabolic process occurs at an accelerated pace, there is increased activity, sweating increases. Both weight and mood change frequently.

Blood pressure elevated, disturbed sleep, difficulty falling asleep. Nervous exhaustion of a teenager is manifested, because the body does not have time to rest during a bad dream.

Hypothyroidism can be congenital or acquired. If at the birth of a baby an underestimated function of the organ is recorded, then a diagnosis is made - cretinism.

The symptoms are as follows:

The little one is lethargic.
Constipation is present.
Sucking is very sluggish.
Jaundice slowly passes.
The temperature is slightly lower.
Hoarse voice.

The normal development of the baby is possible if the problem is identified immediately and treatment is prescribed. This disease is very rare. Statistics say that for 4,000 babies, only one can have such a pathology. Girls are affected twice as much as boys. When the thyroid gland is enlarged, the child most often experiences delayed teething.

Due to disorders occurring in the pituitary gland or hypothalamus, there is a risk of manifestation of secondary hypothyroidism.

Symptoms of the disease:

tearfulness;
amorphous, no desire to move, run, jump;
drowsiness;
depression.
Obesity appears, hair is faded, brittle.

Even 6-year-old patients stop playing outdoor games. For them, a lot of work is the study and knowledge of simple things.

Adolescents with hypothyroidism show an inert state, without a desire to learn anything, their movements are sluggish, they are uncommunicative with peers, have bad memory. Physical, mental, sexual maturation comes later. Teenage girls have problems with menstrual cycles. There are problems with the heart, pressure, nervous twitching of the fingers.

If seen similar symptoms, it is necessary to consult with the endocrinologist. Treatment of malaise with special medications will take some time. If you do not engage in treatment, then you need to prepare for a thyrotoxic crisis, for heart disease and fragile bone tissue.

One of known causes manifestations of hyperthyroidism is an autoimmune disease - Graves' disease. The development of Graves' disease is slow, the symptoms at the initial stage are invisible. Girls are more affected by this disease than boys. With an imperceptible change in the volume of the thyroid gland, the child manifests: bulging eyes, nervousness, diarrhea, memory problems.

Children get thyroiditis adolescence. Approximately 60% of identified patients had a genetic predisposition to this type of disease. Girls are affected more often than boys, about five times more.

At the initial stage, the diagnosis is determined by hyperthyroidism, then hypothyroidism. Signs by which Hashimoto's thyroiditis can be determined at the very beginning: the student is lagging behind, both in studies and in physical growth. Otherwise, the thyroid gland in children gives the same symptoms that are characteristic of hyperthyroidism and hypothyroidism.

Graves' disease affects girls. It can occur together with diabetes, vitiligo.

endemic goiter occurs due to insufficient intake of iodine. Nodular goiter, with this disease, neoplasms are group or single.

The disease is easier to prevent than to treat. Therefore, an attentive attitude to your child will help to diagnose the disease in time. At frequent appearance malaise, overwork, frequent headaches, you should immediately consult a doctor.

The thyroid gland of a child differs from an adult only in size. It looks like the letter "H": it has two parts connected by an isthmus. This organ produces important hormones such as thyroxine (T4), triiodothyronine (T3) and calcitonin. They are responsible for the growth and development of the body, puberty, metabolism and many other processes. Violation of the synthesis of these hormones in the thyroid gland in children leads to serious problems with mental and physical development.

The change in the volume of the thyroid gland in children depending on age can be traced in a special table.

Age	The size of the thyroid gland in children
	boys	Girls
0-2	0,84+0,38	0,84+0,38
2	2,0+0,4	2,0+0,4
4	1,4-2,0	1,3-1.7
5	1,8-2,6	1,6-2,2
6	2,1-2,9	2,1-2,9
7	2,8-3,8	2,4-3,4
8	3,1-4,3	3,1-4,3
9	3,4-4,6	4,0-5,6
10	3,6-5,0	4,2-5,8
11	4,2-5,8	4,4-6,0
12	5,0-7,0	6,3-8.7
13	6,3-8,7	7,0-9.6
14	6,9-9,5	7,2-10,0
15	8.1-11.1	9,0-12,4

Table of norms for the size of the thyroid gland in children.

The gland begins to form at 3-4 weeks prenatal development. At week 8 she takes correct form and begins to function, on the 10th week it develops the ability to absorb and accumulate iodine. From the 12th week, hormone production begins, and by the 36th week, the gland is considered fully developed and has the same functions as in adults. However, by the time thyroid development is completed in children inside the womb, maternal hormones do not stop working.

Interesting fact: this endocrine organ is formed from digestive tract, developing from the process of the digestive tube.

Signs of thyroid disease in children

Thyroid diseases in children and adults are often associated with a lack or excess of iodine in the body. Its excess leads to excessive production of the hormones T3 and T4, and its deficiency leads to a decrease in the functions of the gland. Both excess and deficiency of thyroid-stimulating hormones negatively affect the growth and development of the child. Often, such diseases in children occur due to problems during pregnancy (for example, with insufficient intake of hormones or iodine from the mother).

Another one possible reason thyroid pathology - diseases of the hypothalamus or pituitary gland. The pituitary gland is an endocrine organ located next to the brain and is responsible for the production of many hormones, such as prolactin, somatotropin, TSH and many others. The hypothalamus controls the activity of the pituitary gland. For traumatic brain injury, some infectious diseases(meningitis, encephalitis) or in the presence of a tumor, the functions of the hypothalamic-pituitary system can noticeably decrease, which is reflected by a violation of the thyroid gland in children.

Fact: TSH produced by the pituitary gland is closely related to T3 and T4: a high level of them suppresses TSH, and a low level of the pituitary gland increases the production of TSH to stimulate the production of thyroxine and triiodothyronine.

Symptoms of thyroid disease in children:

low activity, rapid fatigue;
insomnia;
depression, apathy;
slow growth;
early puberty or, on the contrary, its delay;
enlarged eyeballs;
feeling of a lump in the throat;
bad condition skin, hair and nails;
work disruption of cardio-vascular system;
unstable blood pressure;
overweight or severe thinness;
high blood cholesterol.

In the presence of several of these symptoms, it is imperative to show the child to an endocrinologist. They may indicate the presence of a thyroid disease:

hypothyroidism;
hyperthyroidism (thyrotoxicosis);
inflammation of the gland (thyroiditis);
nodular or diffuse goiter;
tumors or cysts.

hyperthyroidism

Hyperthyroidism, or thyrotoxicosis, is caused by an excess of thyroid hormones. The main reasons for this overabundance are hyperactivity of the gland or its damage, excess iodine in the body, autoimmune diseases, and genetic predisposition.

Fact: Hyperthyroidism in children is most often found in adolescence, during puberty.

Symptoms increased function thyroid glands in children:

hyperactivity;
frequent mood swings;
capriciousness, irritability;
hand tremor;
leanness against the background of increased appetite;
increased sweating;
the appearance of goiter, etc.

To establish an accurate diagnosis, it is necessary to take tests for T3, T4 and TSH, to do an ultrasound of the thyroid gland, an ECG. Hyperthyroidism is easily determined by all these data.

Typically, therapy this disease wears medicinal nature. To do this, drugs are prescribed that suppress the secretion of thyroid hormones, but at the same time, the dosage for treating the thyroid gland of children should be less than for adults, otherwise the disease can turn into its opposite - hypothyroidism. Dosage is reduced a few months after establishment stable results, after which the therapy becomes supportive.

Hypothyroidism

Hypothyroidism is the result of an underactive thyroid gland in children. It can be primary (with damage to the gland) and secondary (with damage to the pituitary gland or hypothalamus). In addition, hypothyroidism can be congenital. This form of the disease occurs due to a lack of iodine in the mother's body or improper drug treatment mother during pregnancy.

Fact: existing congenital hypothyroidism is diagnosed in newborns only in 15% of cases; in the rest, it passes in the neonatal period asymptomatically and manifests itself later.

Symptoms of the congenital form:

extended gestation period;
overweight child;
swelling of the face, local swelling of the body;
coarsening of the voice when crying;
long-lasting jaundice;
long healing of the navel;
drowsiness;
low body temperature;
bradycardia (slow heart rate) and etc.

Important! If a reduced thyroid function is detected immediately after the birth of a child, there is a chance complete cure pathology. With a belated diagnosis, mental and physical disability may develop.

Acquired hypothyroidism is similar symptoms which develop gradually in a child: puffiness of the face, poor condition of the skin and hair, slow growth, physical underdevelopment, obesity.

Hypothyroidism is quite easily determined during a medical examination, tests are necessary for an accurate diagnosis. Treatment consists of replacement (sometimes lifelong) therapy with thyroidin.

Autoimmune thyroiditis

It is characterized by inflammation of the thyroid tissue, the appearance of nodes on its surface. This process is autoimmune. The thyroid gland in a child can be enlarged or reduced, depending on the severity of the disease. Typically, there is a familial predisposition to autoimmune thyroiditis. The reasons for the development of pathology can be insufficient function of the gland, the negative influence of the environment, past infections.

A common occurrence is the formation of nodes in autoimmune thyroiditis

Fact: In some cases, the child does not show any symptoms. autoimmune thyroiditis, the disease is diagnosed only at the next scheduled examination.

At diagnosis, levels of antithyroid antibodies are checked. Their elevated level indicates an ongoing autoimmune process. In addition, an ultrasound of the thyroid gland is performed, and, if necessary, a biopsy of the gland.

Treatment is mostly symptomatic; depending on the test results, hormone therapy (L-thyroxine) may be prescribed. The child must be shown to the doctor every six months to adjust the dose of the drug.

Conclusion

Protecting yourself from thyroid diseases is quite difficult. To take care of the health of the unborn child, a pregnant woman needs to fully examine the hormonal background and determine the state of the thyroid gland. Timely treatment helps to warn congenital diseases fetus.

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 in children.

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 (usually yersiniosis) and bacterial diseases, acute and chronic (sinusitis, tonsillitis, etc.);
emotional stress, stressful situations, depression;
excessive insolation (prolonged exposure to direct sunlight);
traumatic brain injury;
in food;
excessive physical activity;
hypothermia;
crash in 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, and 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. Influenced high level thyroid hormones disrupt all types of metabolism.

The main clinical manifestations of DTG:

Damage to the nervous system is 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 the cardiovascular 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 ( top scores) with a decrease in diastolic (lower indicators) blood pressure;
expansion of the boundaries of the heart and mitral valve insufficiency on 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;
trembling of the 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 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 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);
the formation of 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 mental reactions, dystrophic changes in organs.

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

neurohumoral stage: in progress 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. bulge, goiter and rapid pulse- a typical triad for DTZ.

To confirm the diagnosis, additional research methods are carried out:

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;
definition of basal metabolism - helper method diagnosis of 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 of 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, calcium channel blockers (Nifedipine, Verapamil) are used.
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 lowers blood pressure, reduces heart rate, has a calming effect, and normalizes sleep. Of the sedative drugs, Elenium, Seduxen, Trioxazin can be used for severe DTZ, and valerian for moderate form.
IN complex therapy includes appointment vitamin preparations(A, C, B vitamins), 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. Optimal age for surgery - 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 surgery, 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 the toxic effect of thyroxin on the body, being to some extent its antagonist.

The source of these vitamins can be:

boiled meat or fish;
dairy products;
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 intake of enough iodine, which are rich.

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 being discharged from the hospital, a teenager is allowed to go to school after 1-1.5 months, and 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.

The hormonal background is checked quarterly (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 removed from the register after 3 years of the euthyroid state or 2 years after 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.

Working adolescents are contraindicated in severe physical work, 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.

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 in the presence of hereditary predisposition to thyrotoxicosis.

A thyrotoxic crisis can be prevented by strict conservative antithyroid treatment, excluding psychotrauma, 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.

At late diagnosis DTZ does not exclude the development 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 ruled out, which requires taking thyroid hormones throughout life.