Enlarged thyroid gland in a child symptoms. Pathology of the thyroid gland and the risk associated with its development. What symptoms indicate a change in the size of the organ

Improper functioning of the endocrine system occurs not only in adults, but also in children. The hormones produced by the thyroid gland play an important role in the development and growth of the child, which is why it is very important to identify the pathology as early as possible and take all measures to eliminate the consequences. But why is it increased? What can cause thyroid disease? How to properly treat the disease?

Thyroid and child growth

The thyroid gland plays an important role in the development and growth of the child. The hormones that it produces affect the mental development of the child, the functioning of the intestines, heart and other organs. The slightest changes in it immediately affect the work of all organs, which can eventually lead to serious and irreparable consequences.

Diseases in newborns thyroid gland may be detected in the hospital.

Respiratory and later reproductive functions, sleep and skeletal formation also depend on the proper functioning of the thyroid gland. If a beloved child has an enlarged thyroid gland at any age, then health will deteriorate significantly. But what causes the organ to increase?

Reasons for organ enlargement

An increase in the thyroid gland is a change not only in the size and volume, but also in the mass of the organ. Among endocrine pathologies in a child, it is the dysfunction of the organ that occupies a leading place. The main reason that leads to such a change is the lack of iodine in a child, it enters in the womb of the mother and after birth. But the period in the mother's womb is considered the most dangerous, when everything is being laid by the baby's organ, but the first couple of years also need to be monitored for the development of the organ. , such as iodine deficiency, is one of the serious problems that affects more than half of the world's population.

There are several reasons for the growth of the body:

A lack of iodine leads to an increase in the thyroid gland, this condition is necessary so that the body can cope with the problem and produce the right amount of hormones.
Lack of prevention of iodine deficiency in areas where it is insufficient in water and soil.
Poor ecology, children in cities with well-developed industry most often suffer.
Heredity.
Refusal of a child right food and frequent stress.

More often thyroid changes its size in girls than in boys. The degree of magnification may vary.

The degree of increase and mass of the organ

Any even the most insignificant is called a goiter. Feeling the organ during the examination, and assessing its condition visually, the doctor determines the degree of increase:

0 - no changes in the organ were detected, hormones are produced normally;
I - no visual changes were detected, but a slight increase is noticeable on palpation;
II - a notably small increase in the organ when the head is thrown back;
III - the increase is visible even if the head is not thrown back;
IV and V - the thyroid gland is enlarged so much that even the contours of the neck have changed.

In each child at a certain age, the thyroid gland has a certain mass, so, for example, a month after birth, it weighs only one and a half grams, and at six months 2 g, at 5 years old - 6 g, at 10 years old - 9.6 g, and at 18, she already weighs 15 g.

It is constantly necessary to monitor the work of all organs, if any.

The active thyroid gland in a child becomes 5-7 years old and at the time of puberty, since it is he who is considered one of the most powerful stresses for a growing organism. During this period, the thyroid gland greatly increases in girls.

What symptoms indicate a change in the size of the organ?

There are several pathologies of the thyroid gland, which lead to the fact that it increases. Each disease has its own signs, but there are a number of symptoms that will tell you about malfunctions in the child's body:

Body temperature changes, it can be both elevated and reduced.
Intestinal disorders: constipation, diarrhea, flatulence.
Sleep disorders: insomnia.
Fluctuations in body weight - the thyroid gland is responsible for metabolic processes in the child's body, so if it does not work properly, the baby can lose weight or, on the contrary, get better.
There are swelling on the legs and arms, shortness of breath.
Visually, you can notice an increase in the volume of the neck, if the pathology is already in the later stages.
Children aged 7-10 who are attending school may begin to perform poorly in school or fail to concentrate on a task.

signs incorrect operation thyroid glands in a child are not immediately recognized, they are very often confused with other diseases. But if the child has the first signs of changes in the work of the body, then you need to urgently seek advice from an endocrinologist.

Thyroid disorders occurring in childhood

An enlarged thyroid gland in a child may indicate a reduced or increased production hormones. It can also be associated with infections, injuries, and the presence of tumors. In children, such pathologies of the gland can occur:

If the first signs of a malfunction of the thyroid gland appear, you should definitely seek help from an endocrinologist and undergo an examination.

Diagnostic methods

A disease detected at an early stage is easier to cure and does not bring serious consequences to the body. And if nothing is done, the consequences can be very serious. Diagnostics starts with visual inspection a doctor who feels the organ and finds out from the mother all the nuances that made her seek help. If there is the slightest suspicion of the presence of pathologies in the thyroid gland, lab tests on the level of hormones, the amount of iodine in the body. Ultrasound and magnetic resonance imaging are also recommended. If necessary, then take a biopsy. Only after all the examinations, the doctor will be able to make an accurate diagnosis and find the cause that provoked the disease. Newborn babies are examined even in the maternity hospital, because the development of the child is directly related to proper work thyroid glands. If a pathology is detected before a month, then it is possible to provide normal development child's body.

Thyroid disorders are more common in girls than in boys.

Therapeutic therapy of the thyroid gland in children

For the treatment of childhood thyroid pathologies, doctors use several therapy tactics, but each of them may not always be suitable, so you need to select those drugs that are suitable in a particular case. That is why only a doctor should conduct a thorough examination and select the method of therapy individually for each child.

All severe and neglected cases are treated with surgery, after which supportive and rehabilitation therapy. In addition, drugs are prescribed that will replace hormones in the body in the presence of hypothyroidism. Drugs may also be prescribed that will slightly slow down the production of hormones. But even despite this, each child is recommended to prescribe treatment due to increased intake of iodine - these can be drugs in which it is present or a diet enriched with iodine.

IN short time and most importantly, Monastic Tea will help to effectively cure the thyroid gland. This product contains only natural ingredients, which have a complex effect on the focus of the disease, perfectly relieve inflammation and normalize the production of vital hormones. As a result, all metabolic processes in the body will work correctly. Thanks to unique composition"Monastic tea" it is completely safe for health and very pleasant to the taste.

But the drug is also prescribed individually for each child, since an organism that has not yet been formed may not be able to cope with certain drugs. As practice has shown, the therapy of a child can last from 2 months to 2 years. But it is worth remembering that such treatment will not pass without a trace, therefore, undesirable manifestations may appear, therefore it is important to choose the right dose of the drug in accordance with the age and weight of the baby. Parents need to be aware that self-medication can lead to serious consequences, which will end lethal outcome. Treatment is prescribed by an endocrinologist, after a thorough examination.

The parent needs to remember that even the slightest enlargement of the thyroid gland without proper treatment, in adolescence can lead to serious problems at puberty, affect growth and even behavior. Therefore, you should not start the disease, you need to visit an endocrinologist regularly, who will be able to identify the pathology in the early stages and cure them without consequences.

The thyroid gland 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 are various reasons and manifestations, but, unequivocally, deviations in her work have a negative impact on the baby's not yet strengthened health. 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 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 dietary characteristics, inflammatory diseases of the thyroid gland, metabolic disorders, surgical intervention, radioactive exposure. Acquired hypothyroidism is often accompanied by diseases of other endocrine glands (polyendocrine insufficiency) or with 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;
dry 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 replacement hormone therapy and other drugs, the risk of irreversible abnormalities is significantly reduced. In cases where treatment is ignored, the disease takes a severe form and often leads to death.

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 overactivity of the thyroid gland and high level thyroxine in the blood of a child. The problem may be associated with hyperfunction of thyroid cells, metabolic disorders, and also develop against the background of excess 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;
fever body;
irritability, hyperexcitability, aggression;
disorders of the brain;
sleep disturbances, increased fatigue;
metabolic disorders, weight loss;
exophthalmos (protrusion 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 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 child'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. The therapy is reinforced by maintaining an active lifestyle and following a special diet.

Thyroiditis

Thyroiditis is inflammation of the tissues of the thyroid gland of various nature. Depending on the factors that caused inflammation, the following forms of pathology are distinguished:

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. Concerning secretory function thyroid gland, then 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 organ tissue.

The acute form requires a sufficiently long treatment, the patient is prescribed strict bed rest, a course of antibiotics, restorative means 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

Mechanism autoimmune diseases is that as a result of immune failures, specific antibodies are released, which are taken for foreign body cells of your own 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 serious violations work 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, vitamins and diet.

Neoplasms in the tissues of the thyroid gland

Riedel's goiter (Chronic fibrous thyroiditis). This disease is characterized by the growth connective tissue thyroid and 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 squeezing the trachea, esophagus, larynx can 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.

- an organ designed to maintain the ability human body manage and maintain internal environment V constant state(homeostasis). The functionality of the thyroid gland has a direct impact on the state of the whole organism, including even the mood of a person. Problems with the thyroid gland lead to a pathological condition of most organs and systems.

General information

The thyroid gland is an organ that affects the development of a person while still in the womb. Immediately after the birth of the child, they determine her condition. Deviation from the norm in children entails a developmental disorder that manifests itself in several forms of diseases.

In the thyroid gland there is a constant synthesis of the main hormones:

calcitonin
thyroxine
triiodothyronine

All these hormones are responsible for the maturation and growth of organs (tissues) in children. Thyroid hormones also regulate the metabolic and energy functions of the body. A special role is played by calcitonin, which is involved in the formation and development. For these reasons, the thyroid gland is one of the main organs of the child's body.

With thyroid dysfunction, the development of the central nervous system is primarily disrupted, which leads to a deviation of the mental and physical development. Pathology is considered to be an excess of the norm up or down. However, a decrease in the amount of triiodothyronine and thyroxine is most dangerous, especially in fetal development, since it leads to progressive cretinism.

Early plays an important role in restoring thyroid function. When symptoms of thyroid diseases appear in children, a detailed examination is prescribed, including:

tests that measure hormone levels
thermography

The results of laboratory and hardware studies make it possible to determine the pathology in children on its initial stage development, when there is an increase in the size and volume of the organ.

The doctor, when examining a patient by palpation, can determine the consistency of the thyroid tissue, an increase in the gland and the presence of the formed nodes. Treatment after diagnosis in children should begin immediately.

Causes

Thyroid problems in children can be different reasons. It is difficult to determine what exactly provoked, but this is one of the main tasks of specialists. If during the period of treatment the cause of the disease is not eliminated, then the treatment will not give special results. At congenital pathologies only marginal improvements can be made.

Violation of the functionality of the thyroid gland in most cases is provoked by a number of reasons:

bad ecology
malnutrition (especially carcinogens)
deficiency in water and iodine products
selenium in the body

Also, the cause may be a cyst of the ducts of the organ or an autoimmune disease. Hormones of the hypothalamus or pituitary gland negatively affect the thyroid gland.

Congenital and acquired pathologies of the thyroid gland are possible. At congenital form disease significantly affects the state of the thyroid gland of the mother.

General symptoms

There are symptoms of thyroid diseases in children gradually. Over time, the intensity of symptoms increases and is supplemented by concomitant deviations.

weakness
fast fatiguability
discomfort in the heart
persistent pain in the head

Similar symptoms indicate problems with the nervous and cardiovascular systems.

The thyroid gland is an endocrine gland that synthesizes the hormones thyroxine, triiodothyronine, and 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. The child's body grows and develops, and even minor deviations in homeostasis can lead to serious problems.

Diseases of the thyroid gland 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.

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

Hypothyroidism is manifested by the following symptoms:

low body temperature;
hypotension;
drowsiness, increased fatigue, depressed emotional state;
constipation, biliary dyskinesia;
bradycardia;
reduced level of reflexes;
dry 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. Mental deviations, deaf-muteness can develop. 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 a severe form and often leads to death.

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 iodine in the body or taking 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 tic, etc.

Hyperthyroidism is autonomous and associated with dysfunction of the pituitary gland. The autonomous form is caused by tumors and neoplasms in the tissue of the gland 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 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 of the 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. The therapy is reinforced by maintaining an active lifestyle and following a special diet.

Thyroiditis

Thyroiditis is inflammation of the tissues of the thyroid gland of various nature. Depending on the factors that caused inflammation, the following forms of pathology are distinguished:

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, and general weakness. The thyroid gland increases in size, there is an increase in body temperature, cervical lymph nodes increase, the pain becomes pronounced, and increases with neck movements, swallowing and touching. 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, restorative drugs and symptomatic therapy. If secretion disorders are noted, the doctor prescribes drugs to the child to stabilize the balance of hormones. With the development of purulent inflammation, a biopsy and surgical intervention are recommended.

For treatment, glucocorticosteroids and medicines based on salicylic acid and pyrazolone are used. 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 such conditions are caused by 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.

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

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. The general health of the child and the level of hormones do not change, but with a significant increase in compaction, symptoms associated with squeezing the trachea, esophagus, larynx may occur: 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 is one of the most important glands internal secretion, providing direct action on the child's health and well-being. Even minor violations in its functional activity lead to the development of disorders from other glands (pituitary gland, hypothalamus), metabolic processes in the body, changes in mood and appearance.

In this article, we will consider which thyroid diseases are most common in children.

General information about the thyroid gland

Ultrasound of the thyroid gland - informative method diagnosis of diseases of this organ.

triiodothyronine;
thyroxine;
calcitonin.

The first two of them are involved in the regulation of maturation and growth of organs and tissues, metabolic processes in the body. Calcitonin is involved in the development skeletal system and regulates calcium metabolism. Thyroid hormones require iodine and tyrosine (an amino acid) to form.

To assess the function of the thyroid gland, a laboratory determination of the content of hormones in the blood of a child is used. Permissible norms the content of hormones in the blood depends on the age of the children. If a pathology is suspected, the content of TSH, a thyroid-stimulating hormone produced by the pituitary gland and regulating the formation of thyroid hormones, is first determined. If at the same time deviations are revealed, then other hormones are determined: T3 (triiodothyronine) and T4 (thyroxine).

In some diseases, it is important to detect antibodies in the blood (anti-thyroglobulin and anti-thyroperoxidase). From instrumental methods ultrasound, thermography, MRI (magnetic resonance imaging), biopsy are used.

Causes of thyroid disease

Disorders of the thyroid function (excess or lack of hormones) appear with its diseases. These dysfunctions lead to the development various diseases in children.

There are many reasons for the occurrence of thyroid diseases:

poor environmental situation;
poor quality food;
lack of iodine in food and water;
selenium deficiency in the body;
infections;
autoimmune diseases;
ductal cyst.

In addition to diseases, the activity of the thyroid gland is directly affected by the hormones of the pituitary and hypothalamus (brain regions). In turn, the thyroid gland affects their hormonal activity.

Types of thyroid disease in children

Diseases of the thyroid gland in children include:

hypothyroidism: primary (congenital and acquired) and secondary;
thyroiditis (acute, subacute and chronic);
diffuse goiter (Graves' disease);
nodular goiter;
thyroid cyst;
thyroid disease in newborns.

Hypothyroidism

In hypothyroidism, the level of thyroid hormones in the child's blood is usually reduced.

Hypothyroidism refers to endocrine diseases that occurs in children due to reduced thyroid function. Hypothyroidism can be primary or secondary. In primary hypothyroidism, the deficiency of thyroid hormones is associated with a process directly in the gland itself. In secondary hypothyroidism, hormone deficiency is associated with dysfunction of the pituitary or hypothalamus.

There are two types of primary hypothyroidism:

congenital: associated with a defect prenatal development glands or impaired production of thyroid hormones;
acquired: develops with iodine deficiency in the child's diet, after an inflammatory process in the gland, with its radioactive damage, or after surgery on this organ.

Congenital hypothyroidism in infants is caused by:

hypoplasia (underdevelopment) of the thyroid gland;
aplasia ( complete absence) glands due to mutations;
defect in enzymes involved in the production of thyroid hormones;
lack of iodine in the mother's body.

The cause of secondary hypothyroidism is a decrease in the release of thyroid-stimulating hormone as a result of:

birth trauma;
meningoencephalitis (inflammation of the membranes and brain matter);
brain injury;
(hypothalamic-pituitary region).

congenital hypothyroidism(cretinism), according to statistics, occurs in one newborn out of 4000. Moreover, in boys it is observed twice as rarely as in girls. Thyroid hormone deficiency affects the growth of all organs, but the brain is more affected.

Signs of the disease appear in infants from the first days of life: a decrease in body temperature, drowsiness, loss of appetite, slowing of the heart rate.

In the following weeks, other symptoms are clearly manifested: slow development and growth, decreased muscle tone, dry skin, slow reflexes. May appear. Slow growth of teeth is also characteristic.

The treatment started at this stage allows you to get rid of most of these manifestations, except for brain damage. Although the mental development of the child depends on the age at which hormone treatment was started: if the infant receives treatment from the first month of life, then his intelligence may not suffer.

If hypothyroidism is detected, treatment begins immediately. If treatment is started after 1-1.5 months, then changes in the brain will be irreversible. In this case, the pathology will lead to mental retardation and impaired physical development: short stature in such children is combined with disproportionate parts of the body, deaf-mutism and mental inferiority.

Acquired hypothyroidism can be combined with damage to other glands (parathyroid, pancreas, adrenal glands, gonads). These lesions of an autoimmune nature are diagnosed as primary polyendocrine insufficiency. Sometimes these patients also have other diseases with autoimmune mechanism development ( pernicious anemia, and etc.).

In autoimmune processes as a result of disturbances in immune system the body produces antibodies against thyroid cells, which leads to its defeat and insufficient synthesis of hormones.

With hypothyroidism, all types of metabolism (metabolism) are disturbed, which leads to a significant lag not only in physical, but also in mental development child. Sometimes this condition can be suspected by the poor academic performance of the child, the inability to learn the school curriculum.

Clinical symptoms of hypothyroidism:

general weakness;
bad dream;
increased fatigue;
growth retardation and shortening of limbs;
delayed puberty; but there are cases of early puberty at 7-12 years;
girls have menstrual irregularities;
weight gain;
memory loss;
typical appearance of the face: puffiness, wide bridge of the nose, enlarged lips and tongue, eyes far apart, pallor and swelling of the face (myxedema);
dry skin;
hair is dull and brittle;
swelling of the limbs;
impaired coordination of movements;
violation heart rate(interruptions);
fluctuations blood pressure(dystonia);
high cholesterol in the blood serum;
depressed mood, indifference, depression;
constipation.

The mass of the brain may decrease, as nerve cells undergo degenerative changes. Dominant mental retardation. In the future, oligophrenia (mental retardation) manifests itself in varying degrees expressiveness. The child is not interested in games, it is difficult for him to learn something new, to learn something, to play sports. More and more, the baby lags behind in general development.

The face of a child with hypothyroidism (the face of a cretin) may resemble the face of Down's disease. But Down's disease is characterized by: eye shape (Mongoloid), normal view hair and skin, loose joints, Brushfield spots on the iris.

Clinical signs of hypothyroidism largely depend on the age of the child at the time of the onset of thyroid hormone deficiency. But in the foreground - developmental delay, mental and physical. How older child at the time of the onset of the disease, the less developmental delay will be expressed.

With severe and long-term conditions hypothyroidism, there are disturbances in the work of all organs and systems. If left untreated, death is possible.

In hypothyroidism, Thyroidin replacement therapy is carried out throughout life. In addition, courses of treatment with Cerebrolysin are carried out, vitamin preparations. To correct developmental delay, curative pedagogy and physiotherapy. Exercise therapy prevents and eliminates deformities musculoskeletal system, improves metabolism, normalizes the digestive tract.

Hyperthyroidism (thyrotoxicosis) in children

The causes of hyperthyroidism may be different, but its manifestations are the same regardless of the cause.

Thyrotoxicosis is a disease associated with excessive levels of thyroid hormones in the body of a child. The disease develops more often in children from 3 to 12 years old and does not depend on the sex of the child.

Causes of hyperthyroidism can be:

increased thyroid function in the form over-education and secretion of the hormones T4 and T3;
destruction of gland cells and release of previously synthesized hormones T4 and T3;
overdose of synthetic hormonal drugs(thyroid hormones);
overdose of iodine preparations.

An increase in the functional activity of the thyroid gland happens;

autonomous: with tumors of the gland (adenoma or carcinoma) or with Albright's syndrome (see the essence and description of the syndrome below); thyroid tumors in children rarely develop;
associated with stimulation of thyroid function by pituitary hormones.

Albright syndrome consists in the development of one or many adenomatous nodes in the gland tissue with increased function. Clinical manifestations syndrome: in addition to impaired development (dysplasia) of the skeleton, there is patchy pigmentation of the skin and an increase in the activity of the endocrine glands (parathyroid and gonads, adrenal glands).

As a result of these lesions, in addition to hyperthyroidism, there may be: Cushing's syndrome (a disease associated with an excessive amount of hormones of the adrenal cortex), acromegaly (a disease of the pituitary gland with an increase in the feet, hands, facial skull), early sexual development.

Hyperthyroidism in newborns(neonatal hyperthyroidism) is extremely rare (1 in 30,000 newborns). It develops 7 times less frequently than congenital hypothyroidism. The condition does not depend on the sex of the child. Sometimes premature babies are born. Hyperthyroidism in this case is associated with the ingestion of antibodies into the child's body that stimulate the synthesis of thyroid hormones from the body of a mother suffering from Graves' disease. In the baby's body, these antibodies also cause an excess of hormones.

Usually this type of hyperthyroidism is not severe and does not require treatment, since most often the antibodies are removed from the child's body in 2-3 months on their own. In extremely rare cases, with a very high antibody titer, acute thyrotoxicosis may develop, requiring treatment to suppress hormone synthesis. Rarely, congenital (neonatal) hyperthyroidism persists for several years.

With hyperthyroidism of newborns in children, the following signs are noted: an increase in the thyroid gland, anxiety, increased physical activity and excitability of the baby to sound or light, excessive sweating, enlarged lymph nodes, liver and spleen; fever, rapid breathing and palpitations may appear.

There may be yellowness of the skin and punctate hemorrhages, rapid stools. The child's eyes are wide open, as if bulging (exophthalmos). The growth and weight indicators at birth in an infant are reduced due to intrauterine growth retardation. The weight gain is insignificant, although the baby sucks well at the breast. In the blood, the number of platelets and prothrombin decreases.

Clinical manifestations of the disease are detected already after birth, sometimes they appear on the 3rd-7th day, and sometimes later - at 1 or even 1.5 months.

Usually, neonatal hyperthyroidism does not need treatment, its manifestations gradually disappear. Sometimes in transient hyperthyroidism, beta-blockers and potassium iodide are prescribed to suppress the release of previously formed hormones.

Only in some severe cases drugs that suppress the synthesis of thyroid-stimulating hormones are used. This treatment is safe for babies. Behind a short time With the help of these drugs, it is possible to eliminate the symptoms of hyperthyroidism.

Hyperthyroidism can be a symptom of thyroid disorders such as Graves' disease (Graves' disease) and thyroiditis (inflammation of the thyroid tissue), which develops through different mechanisms. Hyperthyroidism in Graves' disease is associated with stimulation of thyroid-stimulating receptors by antibodies to these receptors. Graves' disease is the most common cause(95%) hyperthyroidism in children. Detailed description these diseases, see below.

Regardless of the reason for increased function thyroid gland, thyrotoxicosis has such basic clinical symptoms:

increased heart rate;
increased blood pressure;
an increase in the thyroid gland;
increased sweating;
aggressiveness and irritability, frequent change sentiments;
sleep disturbance;
poor appetite;
weakness and fatigue;
eye symptoms: double vision, a feeling of pressure behind the eyeballs, a feeling of sand in the eyes, "protrusion" of the eyeballs (in neglected conditions);
feeling of trembling in the body;
twitching of the eyelids;
frequent urination at night;
violation of the menstrual cycle in girls;
increase or decrease in body weight of the child.

According to the existing classification, thyroiditis is distinguished:

acute (non-purulent and purulent);
subacute (viral);
chronic Riedel's thyroiditis (fibrous) and Hashimoto's thyroiditis (lymphomatous autoimmune).

Acute thyroiditis can be caused by any acute or chronic infection(ARI, tonsillitis, scarlet fever, tuberculosis, influenza, etc.). Inflammation can also be caused by trauma, lead or iodine poisoning, and sometimes the cause of the disease cannot be determined.

The onset of inflammation may be imperceptible, slow. There is pain in the neck and when swallowing, weakness, hoarseness. The temperature may remain normal. And only after a few days (sometimes weeks) there is an increase in the size of the gland, a sharp pain in the thyroid gland.

The temperature rises, manifestations of intoxication increase (weakness, nausea or vomiting, sweating, headache). Swallowing or moving the head aggravates the pain in the area of the hard to the touch gland. Are increasing cervical lymph nodes. In the blood, the number of leukocytes increases, an accelerated ESR is noted.

At the initial stage of the disease, thyroid function is increased, that is, hyperthyroidism develops, and then transient signs of hypothyroidism may be noted.

Small patients recover after 1 or 1.5 months, but relapses may occur. Full recovery gland function can take up to 6 months.

In addition to a smooth course, there may be cases of severe, fulminant flow, as a result of which suppuration of the gland may develop. The abscess can open through skin outside, but can also open into the esophagus, trachea or mediastinum. Purulent thyroiditis can result in fibrosis of the gland with the development of hypothyroidism.

Principles of treatment acute thyroiditis:

bed rest;
antibiotic therapy up to 3-4 weeks;
with hypothyroidism - the appointment of the hormone L-thyroxine;
detoxification therapy;
symptomatic treatment (painkillers, heart medications, sleeping pills according to indications);
vitamin therapy;
surgery with purulent processes;
diet therapy ( fractional nutrition, liquid food).

Subacute thyroiditis also called granulomatous, it is rare in children. It often develops after viral infections (mumps), therefore, its viral nature is assumed. After these diseases, autoantibodies are found in the blood, which destroy the thyroid tissue, forming tubercles (granulomas) of giant cells.

The manifestations of subacute thyroiditis are an enlarged, painful gland, fever, symptoms of intoxication. Pain is given in the back of the head, in the parotid region.

In the course of the disease, hyperthyroidism with its characteristic manifestations is replaced (as a result of depletion of hormone synthesis) by symptoms of hypothyroidism; the content of thyroid-stimulating hormones decreases.

In the treatment of subacute thyroiditis, drugs of the pyrazolone and salicylic series are also used. Antibiotics are used only when using glucocorticoids.

At the stage of hyperthyroidism, drugs to suppress the function of the gland are not used, since elevated level hormones are not associated with increased synthesis, but with the release of previously formed hormones during the destruction of the tissue of the gland itself.

Since hypothyroidism in this process is transient, thyroid hormones are also not used.

Riedel's goiter has another name chronic (fibrous) thyroiditis. Rarely seen in children. Growth of dense connective tissue (fibrosis) occurs in the gland. The disease develops imperceptibly. A painless woody density formation appears on the neck due to an increase in the gland. The lymph nodes do not increase, the skin over the protrusion is not changed. With a long process, breathing, swallowing may be disturbed; hoarseness of voice appears, sometimes dry cough due to squeezing or displacement of the esophagus and trachea.

The general condition of children does not suffer. The functions of the thyroid gland remain normal.

Surgical treatment: part of the gland and its isthmus are removed to exclude squeezing of the trachea.

Hashimoto's thyroiditis (chronic autoimmune)

IN children's body lymphatic system more active than adults. As a result, children are more likely to develop autoimmune processes. The thyroid gland has a single lymphatic ring with the pharyngeal tonsils, therefore, against the background chronic tonsillitis it develops an inflammatory process.

Has the meaning genetic predisposition To autoimmune processes. Family predisposition is noted in 65% of children, and maternally 3 times more often. A failure in immunity can be provoked by a postponed viral infection, some medications, trauma. But until the end, the cause of the disease has not been studied.

Antibodies are produced against the cells of the thyroid gland itself, which are perceived as foreign, resulting in tissue destruction. When cells are damaged, a significant amount of previously synthesized hormones is released, which leads to temporary hyperthyroidism with corresponding symptoms. This phase of the disease lasts no more than 6 months. In the future, thyroid function decreases, and hypothyroidism develops.

Hashimoto's thyroiditis can develop at any age, but its symptoms appear gradually, and it is difficult to identify the disease in the early stages. Children get sick more often in adolescence, less often in preschool. Girls get sick 4-5 times more often than boys. The first sign is often a sudden retardation of growth. The child's performance often declines.

A protrusion (goiter) appears on the neck, increased fatigue, reduced activity of the child, weight gain, dry skin, and constipation are also noted. The thyroid gland may be painful on palpation. In 5-10% of cases (with an atrophic form), goiter does not develop. Diagnosis is based on the appearance of a goiter.

According to the WHO classification, the following sizes of goiter are distinguished:

0 degree - the thyroid gland is not enlarged, i.e. no goiter;
I degree - the thyroid gland is larger than the distal (terminal) phalanx thumb the child being examined, but not visible to the eye;
II degree - an enlarged gland is both palpable and visible to the naked eye.

In children, goiter II degree is more common. The surface of the gland may be uneven; the gland itself is dense or elastic to the touch, moves when swallowing.

Hashimoto's thyroiditis may be one of the manifestations of a polyendocrine autoimmune syndrome, that is, it can be combined with a lesion different glands internal secretion.

Used for diagnosis various methods: determination of blood levels of thyroid hormones and titers of thyroid antibodies, ultrasound, fine needle biopsy (the most accurate method).

Effective treatment has not been developed. At painful sensations non-steroidal anti-inflammatory therapy is used. There are no convincing data on the effectiveness of immunomodulatory therapy. At the stage of hyperthyroidism, β-blockers and sedatives are used.

In case of severe manifestation of thyrotoxicosis, Metizol is prescribed. In the stage of hypothyroidism, L-thyroxine is used (at the same time, the level of hormones is regularly monitored). With large sizes of goiter, surgical intervention is performed: removal of a part, lobe of the gland.

Graves' disease or Graves' disease- diffuse toxic goiter – one of the autoimmune lesions of the thyroid gland, in which antibodies are formed that bind to thyroid-stimulating hormone receptors. As a result, the synthesis of hormones increases, the thyroid gland increases in size.

Children get sick mainly in adolescence (usually from 10 to 15 years), and girls get sick 8 times more often than boys. In some cases, Graves' disease can be combined with other diseases of an autoimmune nature (vitiligo, and some others).

The clinical picture of Graves' disease in children can be very diverse. In addition to an increase in the thyroid gland, the phenomena of thyrotoxicosis appear with damage to many organs and systems:

From the nervous system: frequent mood swings, tearfulness, irritability, poor sleep, anxiety, fatigue. Some children have uncoordinated movements, twitching, trembling of the fingers, tongue, eyelids. There may be sweating, increased body temperature.
From the side of cardio-vascular system: paroxysmal palpitations, a feeling of pulsation in the epigastric region, in the head and limbs; heart rhythm may be disturbed. The increase in heart rate is constant and early symptom disease - persists in a dream. Systolic blood pressure rises and diastolic blood pressure falls. In the case of a long course of the disease, changes appear on the ECG and the boundaries of the heart expand.
From the digestive tract: thirst, increased appetite, loose stools, liver enlargement. At the same time, there is a rapid and significant weight loss of the child.
Eye symptoms: bilateral exophthalmos (“protrusion” of the eyes) with wide eyes, pigmentation, swelling and trembling of the eyelids, rare blinking, increased eye shine.

With Graves' disease, the thyroid gland always increases. But the degree of its increase is different, and this does not determine the severity of the disease.

Degrees of thyroid enlargement:

I degree - the isthmus of the gland is palpated, but it is not visible to the eye during examination;
II degree - the gland becomes visible when swallowing;
III degree - when viewed from the gland is clearly visible, it completely fills the gap between the muscles of the neck;
IV degree - the gland is sharply enlarged to the sides and forward;
V degree - the size of the gland is very large.

An enlarged gland can compress the trachea and esophagus, causing a violation of swallowing, breathing; voice becomes hoarse.

When probing the gland, you can feel a pulsation, while listening - you can hear noises. More often there is a diffuse uniform increase in the gland, less often with the presence of nodes. In the presence of nodes, a mandatory scan of the gland is necessary to exclude the presence of a cyst or cancerous tumor.

Diagnosis with severe symptoms is not difficult. The diagnosis is confirmed by an increase in the levels of T3 and T4, as well as iodine in the blood, increased activity of the gland during scanning.

Graves' disease in childhood can be mild, moderate, or severe form. In the case of a favorable course, the disease lasts at least one to one and a half years. The layering of any infection contributes to an increase in the symptoms of thyrotoxicosis.

For the unfavorable development of the disease, the occurrence of a thyrotoxic crisis is characteristic. Stress can trigger a crisis infection, exercise stress. A crisis can also develop after an operation to remove part of the gland without preparation (without eliminating thyrotoxicosis).

In children, such a crisis is manifested by significant disorders of the cardiovascular system: sharp rise blood pressure, increased heart rate. The body temperature also rises, motor restlessness, dehydration and adrenal insufficiency develop. The condition can worsen up to the development of coma and even death.

Treatment of chronic thyroiditis

Treatment of children with severe and moderate forms of the disease is carried out in a hospital. Bed rest should be observed for about a month. The diet includes foods containing vitamins and rich in proteins.

In order to inhibit the production of thyroid hormones, Mercazolil is prescribed in the required daily dose for one and a half to two months. Subsequently, the dose of the drug is gradually reduced to a maintenance daily dose. Maintenance therapy is carried out from 6 to 12 months.

In addition to Mercazolil, other drugs can be used, such as Propylthiouracil, Carbimazole. In some situations, the doctor may prescribe a combination of hormone replacement drugs and medicines that suppress thyroid activity. In rare cases, radioactive iodine is used for children.

In addition, symptomatic treatment is carried out ( antihypertensive drugs, sedatives, vitamin complexes).

Children with mild form Graves' disease is treated on an outpatient basis. Assign iodine preparations (Diiodtyrosine) repeated 20-day courses with 10-day intervals between them. Such treatment is not always effective: due to the development of resistance to treatment, relapses may occur.

In these cases, Mercazolil is also used, but the daily doses are prescribed less and the courses of treatment are shorter than in the moderate or severe form.

In case of no effect from the carried out during the year conservative treatment held surgical intervention. However, surgical treatment also does not exclude the occurrence of recurrence of the disease. In addition, the consequence of subtotal removal of the gland may be developed hypothyroidism, which will require the use of hormone replacement therapy for life.

For school after inpatient treatment children are allowed no earlier than 1 or even 1.5 months. with their release from physical activity and an extra day off.

Measures to prevent thyrotoxicosis include the observation of a pediatrician with an increase in the thyroid gland with its function preserved, especially if the child has a family predisposition to the disease. Such children should undergo courses of restorative therapy, sanitize the foci of all chronic infections.

endemic goiter

Goiter in childhood is rare. More often develops endemic goiter associated with insufficient iodine content in the area in the water and in the products received by the child. The hormonal activity of the gland is practically not disturbed. The main manifestation is an increase in the gland, which manifests itself in the form of a convex formation on the neck. At ultrasound examination detect an altered structure of the thyroid gland.

Treatment consists in the appointment of iodine preparations and the use of iodized products.

nodular goiter

Nodes at nodular goiter can be detected by palpation or during ultrasound.

Nodular goiter is a collective concept that includes the presence of formations in the thyroid gland that differ from the tissue of the gland itself in structure, composition and structure. The nodes are tumor formations: malignant and benign. Accurate Diagnosis can be established only on the basis of the results of the survey.

The cause of the appearance of knots can be stress, toxic effects, lack of iodine in the body. Family predisposition to gland damage also matters. There may be several nodes. They may have different densities. Sizes can also vary from 1 cm to so large sizes that the child is having difficulty breathing.

Most often, the nodes are painless. Benign nodes do not cause significant harm to the body, unlike malignant ones, which tend to grow and metastasize.

Sometimes children feel a lump in the throat, difficulty breathing. If any of these symptoms appear, you should consult a doctor. An examination is carried out to clarify the nature of the node. Ultrasound examination helps to detect all nodes at an early stage.

Sometimes other studies are performed (magnetic resonance imaging, computed tomography, fine needle aspiration biopsy).

The main danger of nodes is the possibility of their degeneration into malignant formations. Therefore, regular medical supervision is mandatory. If the node is small, then a quarterly ultrasound control of the node is performed.

The question of treatment is decided only after the diagnosis is clarified. When the node is large, surgery is performed. But it may be ineffective, since nodes can form again if the cause of their occurrence is not eliminated. In addition, after removal of a lobe of the gland, hypothyroidism and the need for lifelong use of hormonal drugs may develop.

Knots large sizes can lead to hyperthyroidism if they produce and secrete hormones along with the gland itself. The nodes can also provoke the development of other diseases of the thyroid gland.

Therefore, their education and treatment should not be ignored. It is necessary to eliminate the causes and factors that contribute to or provoke their occurrence. It is necessary to think over and adjust the child's nutrition, recommend him to get rid of the existing bad habits(teenagers) stressful situations and excessive physical activity, including sports.

Summary for parents

If parents find any increase or protrusion in the child's neck, notice signs of illness or changes in behavior, mood and academic performance, it is necessary to immediately consult a doctor with the child, conduct necessary research. Perhaps the cause of the pathology lies in the thyroid gland and its hormones.

Timely diagnosis and treatment will help prevent a severe form of the disease and irreversible consequences. Many thyroid diseases are successfully treated at an early stage. Forecast with timely and proper treatment favorable.

Which doctor to contact

If there are signs that are suspicious of damage to the thyroid gland, you can contact your pediatrician. After primary diagnosis If problems with the gland are confirmed, the child will be treated by an endocrinologist. Additional help a neurologist, a cardiologist can provide treatment.