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Children & Graves'



Overactive Thyroid in Infancy and Childhood

Graves’ disease in children is less common than Graves’ in adults. The effects are also different for a child compared to an adult. The growth and development of child can be changed by a thyroid that is either overactive (hyperthyroid) or underactive (hypothyroid). It can also be harder to recognize in children who are very active. They may be less likely to complain of feeling sick. Their experience of what “normal” is can mask the emotional and physical symptoms of a thyroid problem.

Therefore, it’s important for the parents to recognize the hyperactivity, irritability or change in growth rate of their child and take him/her to a physician for a checkup. It is not uncommon for parents to suspect that their child has a hyperactivity disorder, a psychiatric/emotional disease, or even a drug abuse problem.

Physicians need to be made aware of any questionable symptoms and also look for signs of thyroid disease that may present themselves in other childhood disorders.  For example, if Attention Deficit/ Hyperactivity Disorder (ADD or ADHD) is suspected in a child, then blood tests should be done to rule out a possible thyroid problem.   Because the symptoms are similar, some children initially diagnosed with ADD or ADHD have later been found to have hyperthyroidism. 

A blood test will determine the child’s thyroid hormone level. If the diagnosis is confirmed by a high level of thyroid hormone level and a low level of pituitary thyroid stimulating level (TSH) the doctor may be able to start treatment at once.

Below is a list of symptoms that may indicate a thyroid problem. These symptoms usually develop slowly, which could explain why many children have symptoms for several weeks or even months before the disease is diagnosed. 

Symptoms of Graves’ in Children: 

  • an enlarged thyroid gland, or goiter
  • difficulty swallowing
  • prominent eyes with or without a “stare”
  • an increase in appetite
  • poor weight gain or loss of weight
  • a sudden growth spurt
  • smoother skin
  • fine-textured hair
  • increase in scalp hair loss
  • rapid pulse
  • increased blood pressure
  • nervousness -- visible shakiness, tremors, wringing hands, kicking feet, difficulty sitting still
  • hyperdefecation or increased urination; bedwetting
  • feelings of weakness or fatigue
  • increased sweating 
  • dislike of hot weather 
  • lack of concentration and attentiveness
  • poor memory skills
  • shaky hands that cause clumsiness and poor handwriting
  • rapid growth of fingernails
  • losses in muscle strength and endurance
  • weak shoulder and thigh muscles observed during playtime or sports
  • erratic thought patterns and behaviors
  • irritability; mood swings
  • attitude changes
  • emotional outbursts  (i.e. crying or yelling)
  • out-of-control or bizarre behaviors that require immediate help
  • difficulty falling asleep and/or poor sleep patterns
  • delays in development during normal puberty (i.e., facial and pubic hair may not develop, genitals may not enlarge)
  • changes in menstrual periods

Treatment Options:

Oral Medications:

Treatment for children usually starts with antithyroid drugs (ATDs).  The use of oral medications, usually methimazole (Tapazole) will block thyroid hormone production, which usually helps the symptoms subside within six to eight weeks. 

RAI:

A second treatment option involves radioactive iodine (RAI), which destroys the thyroid gland.  RAI helps the symptoms subside within three to six months.  RAI is used with older children, children with active symptoms after two years, noncompliant children, and children with serious reactions to ATDs.  It is generally used in "tough" cases because children are more sensitive to the possible complications and risks of radiation.  They also have more difficulty than adults with following certain precautions needed after RAI treatment and regulating their medication when they go hypothyroid.

Surgery

Surgery (thyroidectomy), removing part or all of the thyroid gland to stop thyroid hormone production, is usually the last resort for children five years and older.  This third treatment option is used when thyroid nodules are detected and/or cancer is suspected, when ATDs or RAI didn’t work, or when RAI isn’t available.  Surgery can offer rapid and long-term resolution of hyperthyroidism if a near-total thyroidectomy is performed.  However, there are several complications.  The use of anesthesia with children is different than with adults, and children are smaller and more difficult to operate on.  Also, many doctors don't want to take the chance of surgical injury to the nerve supplying the vocal cords (resulting in a change in voice or permanent hoarseness) or accidental injury to the parathyroid glands (resulting in a calcium imbalance). Occasionally, the thyroid tissue remaining after surgery will regrow, which is more common in children than in adults.  Surgery will also leave a small scar in the crease of the child’s neck.  Following surgery, children will require the use of thyroid hormone replacement medication for life. 

Finding a Specialist:

Once you have determined from your child’s primary care physician that they have Graves’, you will need to be referred to a Pediatric Endocrinologist.   Parents are advised to find a pediatric endocrinologist who has experience with Graves’ patients and treatment options.  If needed it is also recommended to have a second opinion on any treatment options.  Whatever physician a parent chooses, they must be comfortable with the doctor and their course of care for their child.

 

Parents Coping /Helping their Child:

Treatment can be a slow process, but psychological symptoms should diminish with treatment.  Unfortunately, some of the cognitive effects on memory and concentration seem to continue even after treatment.  Symptoms can come back, and it can be hard for parents to find the balance between being tuned into the disease and enjoying normal life activities with their child.

It is natural for parents to see their child as perfect, and the diagnosis of Graves’ disease may change a parent’s view of the child.  Common reactions to the diagnosis range from denial, grief for the loss of a perfect child, feelings of guilt, inadequacy, and anger to final acceptance and adjustments to daily life.  Coping with a child with Graves’ disease can also create conflict between parents.  Throughout the diagnosis and treatment stages, parents need to remember to take care of themselves, also.  They shouldn’t hesitate to seek professional counseling and/or support from other parents who have children with the disease.

The Individuals with Disabilities Education Act (IDEA) of 1997 and Section 504 of the Rehabilitation Act of 1973, both federal laws, could provide help to parents and their child who is struggling with Graves’ symptoms in the school setting.  Individualized plans under these laws may provide accommodations, modifications, support services, and/or supplemental aids for students who are medically, physically, emotionally, or intellectually disabled.  Generally, the IDEA focuses on ways to provide free, appropriate education to students with disabilities and is referred to as Special Education.

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