Symptoms of inflammation of the thyroid gland in children. Thyroid diseases in children and their effect on the body

Thyroid- this is a gland internal secretion, synthesizing 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 diseases in children require special attention. A 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, of course, deviations in its functioning negatively affect the baby’s still fragile health. Any problems require immediate and systematic treatment under the strict supervision of an endocrinologist and taking into account all contraindications. Let's look at 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 caused by defects of the thyroid gland itself and can be congenital (cretinism) or 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 an 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, difficult absorption of iodine due to diet, inflammatory diseases thyroid gland, metabolic disorders, surgery, radiation exposure. Often acquired hypothyroidism is accompanied by diseases of other endocrine glands (polyendocrine insufficiency) or with autoimmune processes.

Secondary hypothyroidism develops when the regulatory function of the pituitary gland or hypothalamus is disrupted. These glands, located deep in the brain, secrete thyroid-stimulating hormone, thereby controlling the synthesis of hormones. The initiating factors in 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, increased fatigue, depressed emotional state;
constipation, biliary dyskinesia;
bradycardia;
decreased level of reflexes;
dryness skin, deterioration of hair and nails;
weak muscle tone;
swelling of the face and limbs;
metabolic disorders, obesity;
delayed teething in infants;
decreased brain activity and intellectual abilities;
body disproportion, short stature (as a result of impaired calcitonin synthesis), etc.

Congenital deficiency of thyroid hormones affects girls twice as often as boys. Disorders of the thyroid gland in infancy lead to the development of cretinism. Cretinism is characterized by a low rate of growth and maturation of the child’s body, and brain damage. May develop psychical deviations, deaf-mute. In an advanced state, cretinism can lead to the development of oligophrenia - a persistent and irreversible delay in mental development.

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

Therapy is aimed at eliminating or neutralizing the cause. Depending on the factor that caused the disorder, thyroxine and other hormones, potassium iodide and vitamin complexes are prescribed; physical therapy and 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 high levels of thyroxine in the child’s blood. The problem may be associated with hyperfunction of thyroid cells, metabolic disorders, and may also develop against the background excess content iodine in the body or intake hormonal medications. Children aged 3 to 12 years are most often affected. With this pathology the following symptoms are observed:

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

Hyperthyroidism can be autonomous or associated with dysfunction of the pituitary gland. The autonomous form is caused by tumors and neoplasms in the gland tissue of various 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 pregnancy. Antibodies enter the fetal bloodstream from the mother's body, stimulating the production of thyroid hormones. Antibody levels are determined through a blood test. Usually, the baby's condition stabilizes without major medical intervention a few months after birth.

Traditionally, treatment of the disease is aimed at eliminating the cause of the disease. Depending on the factor that triggered the development pathological condition, the doctor prescribes the child receptor blockers that are complementary to thyroid hormones, medications 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 following a special diet.

Thyroiditis

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

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

Thyroiditis is characterized by pain in the thyroid gland, changes in voice, general weakness. The thyroid gland increases in size, there is an increase in body temperature, and enlarged cervical The lymph nodes, the pain becomes severe and intensifies with neck movements, swallowing and touching. A blood test shows an excess of leukocyte levels. As for the secretory function of the thyroid gland, at the first stage there is excessive secretion of hormones, which then turns into hypothyroidism. In some cases, purulent formations and abscesses occur in the organ tissue.

The acute form requires quite a long treatment; the patient is prescribed strict bed rest, a course of antibiotics, restoratives and symptomatic therapy. If secretion disturbances are noted, the doctor prescribes medications to the child to stabilize the balance of hormones. During development purulent inflammation Biopsy and surgery are recommended.

The subacute form is accompanied by the formation of granulomas - formations of 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 medications based on salicylic acid and pyrazolone. Drugs to stabilize hormonal levels are usually not prescribed in this case.

Autoimmune lesions of the thyroid gland

The mechanism of autoimmune diseases is that, as a result of immune failures, specific antibodies are released, which mistake the cells of their own body for a foreign body and destroy them. Often such conditions are caused hereditary factors and are provoked by infectious diseases. Surveys show that usually autoimmune processes are not limited to just 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 enlarges, a goiter forms, 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. medications are used to stabilize hormonal levels, anti-inflammatory drugs, and sometimes surgical intervention is required.

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

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

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

Neoplasms in thyroid tissue

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

The thyroid gland in children is the main organ humoral regulation, responsible for the formation of the entire organism, in particular, the mental and psychological sphere. When it malfunctions, many serious pathologies develop, including physical and mental retardation. mental development, which develops into serious disease- cretinism. Thyroid diseases can be completely cured with early stages, in this case no irreversible changes will occur and the disease will be stopped.

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

The productivity of the functions of many organs: heart, intestines, kidneys and others depends on the functioning of the thyroid gland. 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, it is formed musculoskeletal system, genitals, nervous and respiratory system. Brain functions, sleep patterns, and behavioral processes depend on the balance of hormones.

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

Causes of diseases

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

The main reason for the malfunction of the gland is iodine deficiency in intrauterine development. The critical period is considered to be the moment when the humoral system is formed in the fetus. If during this period the mother experienced a lack of microelements, the child requires clinical observation both immediately after birth and for several years after it.

The fundamental factors for changes in organ tissue are:

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

Due to a lack of iodine, the thyroid gland increases in size and weight, 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?

The main diseases of the thyroid gland in young children:

Hyperthyroidism - increased activity of the thyroid gland;
Hypothyroidism - insufficiency of the thyroid gland with a decrease 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 examination

If a malignant tumor is suspected, additional research methods are used: scans using radioisotopes, biopsy of 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 thyroid tissue is divided into degrees depending on the severity of the changes.

Gland weight for children of various 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 a lack of iodine in food and a deteriorating environmental 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. If a woman lacks iodine during pregnancy, 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 develop that occur in adulthood:

Hypothyroidism occurs in one in four thousand newborns, and the percentage of cases in girls is twice as high as in boys. The cause of the disease is the underdevelopment of 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 a child can be stopped if therapy for congenital hypothyroidism is started immediately, if the disease is 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, leading to an acceleration of metabolism and loss of muscle mass. In addition, there is tachycardia, increased breathing, arterial hypertension. Sweating increases, tremors of the limbs, and nervous tics occur. Behavioral disorders include anxiety, tearfulness, increased 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 gland cells. The child's growth and development slow down, and a characteristic goiter appears. With this type of disease in the anamnesis, the following are noted: decreased performance, chronic fatigue, dry skin, drowsiness, lethargy, spontaneous weight gain. Treatment is indicated 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 there is a constant lack of iodine in water and food, children develop endemic goiter, which manifests itself in various disorders:

feeling weak
fatigue is higher. What does a healthy child have?
discomfort, feeling of tightness behind the sternum
Frequent, lingering headaches that become permanent over time

Disturbances in the functioning of the cardiovascular and nervous systems also develop.

During chronic iodine deficiency, the thyroid gland slowly grows, compressing the trachea and blood vessels. The child complains of a “lump in the throat,” and the discomfort intensifies when lying down. 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

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

lymphocytic inflammation of gland tissue
benign tumor of glandular tissue
pathological location normal tissue organ
thyroglossal duct cyst
cystic lesion of one of the lobes of the thyroid gland with hypertrophy of adjacent 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, the anterior part of the goiter thickens. Often the neoplasms have an irregular or asymmetrical shape.

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

Due to compression of the trachea and larynx, a feeling occurs foreign body in the throat
Hoarseness of voice, as with a cold
attacks of suffocation, difficulty breathing, frequent attacks painful dry cough

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

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

Diagnosis and treatment

The disease is most easily treated with early stage, if the disease is neglected, irreversible changes may occur, and complications that begin will entail a risk to the child’s health, development and life.

Diagnostics is carried out in stages:

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

Data analysis makes it possible to determine not only the degree of change in the mass, shape and volume of an organ, but also to find out the cause of the development of pathology. A modern healthcare program provides for the identification 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.

Therapy is based on compensation of iodine deficiency, iodine-containing drugs are prescribed and biological supplements. The dosage of drugs, their combination and duration of therapy are determined by the attending physician based on examination data. Self-medication or stopping medications on your own is prohibited!

For hypothyroidism, drugs that stimulate the production of hormones or drugs that perform a replacement function are prescribed

During the period of hyperthyroidism, medications are indicated that reduce the activity of the gland and eliminate excess hormones. Congenital overactivity of the thyroid gland cannot be treated: hormones obtained from the mother’s blood leave the body on their own; in severe cases, they can be removed with the help of medications

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 hospital

If conservative treatment does not produce results and the gland continues to enlarge, surgical intervention with excision of the enlarged area of the organ is indicated.

Summary for parents

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

Thyroid diseases can be prevented by including iodine-containing foods and vitamins in the child’s diet. If there is a lack of iodine in water and food, a specialist will prescribe medications 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 various violations thyroid gland, provoke hyperthyroidism and various pathologies of the hormonal system.

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

If there is a malfunction of at least one function, it will definitely affect your health.

In such a situation, manifestations of serious illnesses, delays in 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.

If the production of hormones is insufficient, special external signs of this situation will not be noticeable until a certain time. Only in more mature age will require lifetime use replacement therapy.

Ecological deterioration and insufficient consumption of iodine in food are the main reasons for the increase in the number of diseases.

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

The gland produces three main hormones:

triiodothyronine;
thyroxine;
Calcitonin takes part 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, and regulate metabolic processes.

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

Increased levels of radiation affect the functioning of the gland. Especially for residents living in areas of high radioactivity. It is they who are more likely to detect neoplasms on the organ.

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

The size of the thyroid gland in children is determined by ultrasound. The volumes of this organ are different for boys and girls of the same age. In order to detect an early stage disease, it is very important to conduct research. These studies will help determine hormone levels and understand the pathology of the disease. All studies help to accurately determine the degree of damage to the organ to be prescribed. necessary treatment.

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

Types of illnesses that occur at a young age:

hyperthyroidism;
hypothyroidism;
diffuse goiter;
thyroiditis.

If you miss the moment of identifying thyroid ailments of the younger generation, you may miss treatment at an early stage, then possible big problems with 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 every disease depends on the unstable state of the endocrine organ.

External signs, giving a reason to see a doctor:

Children at risk, that is, those who are often ill and whose immune system function is reduced. 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, which are supposed to neutralize viruses and bacteria, is reduced.
When the baby's heartbeat is irregular.
By the appearance of the baby, you can understand that there may be problems associated with the endocrine organ. The physical condition may be sluggish, the skin dry, and swelling may occur.
Schoolchildren are plagued by drowsiness, inattention, and difficulty concentrating. Such signs more often indicate a loss of interest in learning, but they also indicate possible development illness.
When a child's growth lags behind that of his peers. The rate of increase in height per year is approximately 4 cm.
If anemia is present and iron-containing preparations there is no expected result, this is a reason to check the condition of the thyroid gland.
Frequent constipation.
Radiation background has increased.

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 in order to identify the real reason frequent infectious diseases. By the way, overconsumption antibiotics can provoke the appearance of hypofunction of the thyroid gland.

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 normal growth of the body. There are no essential or non-essential vitamins. For example, you don’t need a lot of iodine, 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.

You should be careful in cases where parents are in alcohol addiction.

An enlarged thyroid gland in children is diagnosed between the ages of 3 and 12. The congenital disease is observed in only one patient out of 30,000 births. The disease is transmitted from a woman in labor if she suffered from Graves' disease.

A baby suffering from hyperthyroidism initially does not gain the required weight and is delayed in growth development; sometimes they are born prematurely. The baby is easily excitable, very active, suffers from diarrhea, profuse sweating, weakly gaining weight. Over time, the mother's hormones are eliminated from the baby's body without intervention. That's why clear signs only appear in the first few weeks of his life.

The disease is recognized by general symptoms that indicate problems with the gland.

The temperature changes frequently.
The presence of diarrhea or constipation, that is, problems with digestion.
Digestive problems can cause weight fluctuations.
Problems falling asleep.
Irritability, lethargy are the results bad sleep.
It is difficult for a student to concentrate.
The volume of the neck increases in the later stages.

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

Blood pressure increased, restless sleep, difficulty falling asleep. A teenager becomes nervously exhausted because the body does not have time to rest during poor sleep.

Hypothyroidism can be congenital or acquired. If decreased organ function is detected at the birth of a baby, a diagnosis of cretinism is made.

The symptoms are as follows:

The little one is lethargic.
There is constipation.
Sucking is very sluggish.
Jaundice goes away slowly.
The temperature is a little low.
Hoarseness of voice.

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 out of 4,000 babies, only one may have such a pathology. Girls are twice as susceptible to this disease as boys. When the thyroid gland is enlarged, the child most often experiences delayed teething.

Due to disturbances occurring in the pituitary gland or hypothalamus, there is a danger of secondary hypothyroidism.

Symptoms of the disease:

tearfulness;
amorphousness, no desire to move, run, jump;
drowsiness;
depressive state.
Obesity appears, hair becomes faded and brittle.

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

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

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

One of known reasons manifestations of hyperthyroidism are an autoimmune disease - Graves' disease. Graves' disease develops slowly, and symptoms are not noticeable at the initial stage. This disease affects girls more than boys. If there is an unnoticed change in the volume of the thyroid gland, the child may experience: bulging eyes, nervousness, diarrhea, and 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.

At the initial stage, the diagnosis is hyperthyroidism, then hypothyroidism. Signs by which Hashimoto’s thyroiditis can be identified at the very beginning: there is a student’s lag, both in academics and in physical growth. Otherwise, the thyroid gland in children exhibits the same symptoms that are characteristic of hyperthyroidism and hypothyroidism.

Girls suffer from Graves' disease. It can occur together with diabetes and vitiligo.

Endemic goiter occurs due to insufficient iodine intake. Nodular goiter, with this disease, neoplasms can be grouped or single.

The disease is easier to prevent than to treat. Therefore, paying close attention to your child will help diagnose the disease in time. At frequent appearance malaise, fatigue, 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 to each other 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. Disruption of the synthesis of these hormones in the thyroid gland in children leads to serious problems with mental and physical development.

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

Age	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 normal sizes of the thyroid gland in children.

The gland begins to form at 3-4 weeks intrauterine development. At 8 weeks she takes correct form and begins to function, at 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 the thyroid gland in children completes development inside the womb, maternal hormones continue to act.

Interesting fact: this endocrine organ is formed from digestive tract, developing from a 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 arise due to problems during pregnancy (for example, due to insufficient intake of hormones or iodine from the mother).

Another one possible reason thyroid pathologies - 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 injuries, some infectious diseases(meningitis, encephalitis) or in the presence of a tumor, the functions of the hypothalamic-pituitary system may noticeably decrease, which is reflected by impaired activity of the thyroid gland in children.

Fact: TSH, produced by the pituitary gland, is closely related to T3 and T4: high levels suppress TSH, and when low, the pituitary gland increases TSH production to stimulate the production of thyroxine and triiodothyronine.

Symptoms of thyroid disease in children:

low activity, 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;
malfunctions of cardio-vascular system;
unstable blood pressure;
overweight or very thin;
high blood cholesterol.

If several of these symptoms are present, it is imperative to show the child to an endocrinologist. They may indicate the presence of a particular 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 excess 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 changes;
moodiness, irritability;
hand tremors;
thinness 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, do an ultrasound of the thyroid gland, and an ECG. Hyperthyroidism is easily determined by all these data.

Typically, therapy of this disease wears medicinal nature. For this purpose, drugs are prescribed that suppress the secretion of thyroid hormones, but the dosage for treating the thyroid gland in children should be less than for adults, otherwise the disease may turn into its opposite - hypothyroidism. The dosage is reduced several months after establishment stable results, after which therapy becomes supportive.

Hypothyroidism

Hypothyroidism is a consequence 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 mothers during pregnancy.

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

Symptoms of the congenital form:

increased gestation period;
overweight child;
swelling of the face, local swelling of the body;
deepening 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 reduced thyroid function is detected immediately after the birth of a child, there is a chance complete cure pathology. If diagnosis is delayed, mental and physical disabilities may develop.

Acquired hypothyroidism has similar symptoms, which develop gradually in the 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 and the appearance of nodes on its surface. This process is autoimmune. The thyroid gland in a child can be enlarged or reduced, it depends on the severity of the disease. As a rule, there is a family predisposition to autoimmune thyroiditis. The causes of the development of pathology can be insufficient function of the gland, negative environmental influences, and previous 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 during the next scheduled examination.

During 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 mainly symptomatic; Depending on the test results, hormonal 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

It is quite difficult to protect yourself from thyroid diseases. To take care of the health of the unborn child, a pregnant woman needs to fully examine her hormonal levels and determine the condition of her thyroid gland. Timely treatment helps prevent congenital diseases fetus

Diffuse toxic goiter(TG), or thyrotoxicosis (Graves' disease), is a disease of an autoimmune nature, 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), boys are susceptible to the disease 8 times less often than girls. The incidence in adolescents accounts for about 24% of the total incidence. Congenital DTD 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 trigger the development of thyroid disease in children:

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

The development of DTZ can also be triggered by diseases such as vitiligo and 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. In this case, thyroid hyperfunction develops without inflammation of the gland tissue.

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

Symptoms

The development of the disease is gradual, periods of exacerbations and remissions are possible. The first manifestations in children are often touchiness, tearfulness, irritability, and even aggressiveness. The child constantly fusses, talks excessively, and has difficulty concentrating. School performance is declining.

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

Manifestations of DTZ in children are very diverse - they reflect damage to many systems: cardiovascular, digestive, nervous, and visual organs. Influenced high level thyroid hormones disrupt all types of metabolism.

The main clinical manifestations of DTZ:

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;
twitching of the limbs and loss of coordination are possible.

Pathology of the cardiovascular system manifests itself:

attacks of palpitations;
increased heart rate (persists during sleep);
arrhythmia in the form of extrasystoles;
sensation of pulsation in the limbs, head, epigastric region;
shortness of breath;
increase in systolic ( top indicators) with a decrease in diastolic (lower values) blood pressure;
expansion of the borders of the heart and mitral valve insufficiency on late stages diseases.

Damage to the gastrointestinal tract is indicated by the following signs:

with increased appetite;
thirst;
stomach ache;
stool is increased due to intestinal hypermotility, but is formed (sometimes mushy), and diarrhea is not typical;
nausea;
enlarged liver, often developing thyrotoxic autoimmune hepatitis with jaundice and increased liver enzymes;
biliary dyskinesia.

Damage to the organ of vision (ophthalmopathy) is reflected by the following symptoms:

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

There is often a feeling of sand in the eyes, lacrimation, photophobia, and rarely double vision. Smoking makes these symptoms worse. All eye symptoms have diagnostic value.

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

When palpating the gland, pulsation is determined, and using a stethoscope, the doctor listens to vascular murmurs. An enlarged gland can cause changes in your voice and make it difficult to breathe or swallow. Teenagers, due to an enlarged gland, experience a feeling of neck compression, so they try not to wear high-neck sweaters and unbutton the top button on their shirt.

Enlargement of the gland (goiter) is often diffuse, but 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 DTZ is tender, warm, moist, and the palms are also typical – hot and moist. Often appears itchy skin. Children's hair and nails are more brittle.

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

Complications

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

A crisis can be triggered by:

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

Symptoms thyrotoxic crisis are:

high fever;
increased heart rate up to 200 beats/min;
disturbance of heart rhythm such as atrial fibrillation;
excessive agitation and anxiety, even to the point of psychosis;
diarrhea and vomiting;
increase in the amount of urine per day;
progressive dehydration of the body;
muscle weakness up to paresis;
decreased blood pressure;
jaundice;
impaired consciousness (possible coma);
cardiac and adrenal insufficiency, leading to death (in 20-25% of cases).

Other possible complications of DTG:

damage to retrobulbar tissue (located behind eyeball) in the form of scars can lead to irreversible ophthalmological disorders;
bulging eyes and infection of the eye can lead to clouding of the cornea (formation of a cataract);
compression of the trachea by 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 influence of thyroid hormones (diabetes disappears upon recovery from thyrotoxicosis);
development of arterial hypertension in adolescents;
if unsuccessful surgical treatment possible development of hypothyroidism (insufficient 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 upon examination, but the isthmus of the gland is palpable;
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: huge size of the gland.

Thyrotoxicosis severity can be:

mild degree: heart rate up to 100 per minute, body weight reduced to 20%, increase in basal metabolism - about 30%, eye symptoms Not yet;
moderate degree: pulse rate up to 130 beats/min, body weight loss is 30%, basal metabolic rate is increased by 60%, eye symptoms are clearly expressed;
severe degrees are 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: occurs toxic effects on the body of an excess amount of hormones synthesized by the gland;
visceropathic: characterized by pronounced pathological changes functions of internal organs;
cachectic: the body is depleted, changes in internal organs can be irreversible - in the absence of immediate help it can be fatal.

Diagnostics

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

You can suspect DTZ in a child based on an examination and interview, analyzing the teenager’s complaints and behavior. Boggle eyes, goiter and rapid pulse– a typical triad for DTZ.

To confirm the diagnosis, additional research methods are used:

Ultrasound of the thyroid gland: determination of the actual size of the gland, its structure, decreased echogenicity;
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 is used to determine the degree of iodine uptake 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 - helper method diagnosis of thyrotoxicosis;
ECG records heart rate, detects arrhythmias, signs of metabolic disorders in the myocardium;
biochemical blood test: to determine 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 DTZ are treated in a hospital, and when mild form treatment can be carried out on an outpatient basis. Compliance bed rest recommended up to 3-4 weeks.

In the treatment of DTG, conservative and surgical techniques can be used.

The main drug of conservative therapy is Mercazolil or its analogues (Neomercazole, Methymbazole, Carbimazole, Thyreozol). The medicine has an inhibitory effect on the production of thyroid hormones. The dose and duration of the course are determined individually. A gradual reduction in the initial dose is carried out under the control of the teenager’s pulse rate, body weight, T4 and T3 levels in the blood, and cholesterol levels. These data are taken into account and serve as criteria for the effectiveness of treatment.
A side effect of thyreostatics may be a reduction in the blood of leukocytes, platelets, and anemia. If leukocytes decrease to less than 2.5*10 9 /l, the drug is discontinued and Pentoxyl, Leukogen, Metacil, vitamin complexes. If other blood cells decrease, corticosteroids (Prednisolone) are prescribed.
Upon reaching the euthyroid state ( normal level in the blood of thyroid hormones) maintenance doses of Mercazolil are prescribed (the duration of their administration - 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 suffering from bronchial asthma And chronic bronchitis. In this case, calcium channel blockers (Nifedipine, Verapamil) are used.
From the 3rd week of treatment, small doses of thyroidine or triiodothyronine are prescribed to compensate for the deficiency of thyroid hormones while taking thyreostatics. Hormones are also withdrawn gradually as the euthyroid state is achieved 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. Among the sedatives that can be used for severe forms of DTZ are Elenium, Seduxen, Trioxazine, and for moderate forms - valerian.
IN complex therapy appointment included vitamin preparations(A, C, B vitamins), ATP, calcium preparations.

Regular iodine preparations are not used: firstly, they have no effect in thyroid disease, and secondly, they contribute to the oncological degeneration of the thyroid gland. In the USA, radioiodine is used in cases where thyreostatics have caused complications, when there has been a relapse after surgery, or 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(risk of infertility in the future, the occurrence of inherited gene mutations, the development of leukemia or thyroid cancer). In the United States they believe that this risk is negligible.

Indications for surgical treatment are:

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

Subtotal resection of the thyroid gland is performed. Optimal age for surgery - after reaching 15 years of age.

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

In the event of a crisis:

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

Treatment for thyrotoxic crisis lasts 7-10 days.

Diet

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

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

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

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

The value of dairy products also lies in the fact that they are rich (the need for it increases with DTZ).

Of the vitamins, the most important for thyrotoxicosis are B 1 (thiamine) and (retinol). This is due to the fact that B1 promotes the conversion of glucose into fats and glycogen, and retinol reduces the toxic effect of thyroxine 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.

From the diet you need to exclude dishes and foods that have a stimulating effect on the central nervous system and heart:

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 sufficient quantity iodine, which is rich in.

Exodus

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

Relapse of the disease is possible 2 years after achieved euthyroidism. In the case of an earlier return of symptoms of thyrotoxicosis, it is regarded as untreated thyrotoxicosis.

Clinical examination

After discharge from the hospital, the teenager is allowed to attend school after 1-1.5 months and is exempt from physical education lessons and physical activity. He is given an additional day off.

After permanent treatment, children are observed by an endocrinologist monthly until recovery, and then quarterly. At each visit to the doctor, thermometry, blood pressure measurement, pulse counting, examination and measurement of neck volume are performed.

Hormonal levels are checked quarterly (determining T3, T4 and TSH levels), as well as blood sugar and cholesterol levels. Every 6 months, the teenager is consulted by a psychoneurologist, ENT specialist, dentist, and ophthalmologist.

A teenager is deregistered after 3 years of euthyroid status or 2 years after successful operation. For DTZ Spa treatment contraindicated. If you are in a euthyroid state, you can be treated in local sanatoriums in any season, and in the south - from October to May.

Examination issues

Adolescents with DTD are exempt from school exams until they achieve euthyroidism. With any form of thyrotoxicosis, children are exempt from physical education lessons. Simultaneous study and work are contraindicated.

Working teenagers are contraindicated in heavy physical work, night shifts, working with any type of radiation (in a physiotherapy room, with an old-style monitor, in an X-ray room), in a smoky room.

Prevention

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

observation of children with an enlarged thyroid gland with normal thyroid function;
general health measures, infection prevention;
exclusion of stressful situations;
avoiding excessive sun exposure.

This is especially important when there is hereditary predisposition to thyrotoxicosis.

Thyrotoxic crisis can be prevented by strict conservative antithyroid treatment, exclusion of psychological trauma, and strict preparation for surgery (Lugol's solution).

Summary for parents

Thyrotoxicosis is a fairly severe pathology of the thyroid gland, in which the functions of other organs change and metabolism is disrupted.

At late diagnosis DTZ development is not excluded severe complication– thyrotoxic crisis. With timely diagnosed thyrotoxicosis and proper therapy, the child’s recovery is possible. 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.