Thyroid Conditions

This includes Graves disease. In Graves disease, the child’s own immune system makes antibodies (proteins that normally fight infection) that are not normal and that increase thyroid activity.

This includes Hashimoto’s disease or Hashimoto’s thyroiditis. In Hashimoto’s disease, the child’s own immune system makes antibodies that are not normal and that decrease thyroid activity.

Thyroid nodules are small lumps that form in the thyroid. They can be fluid-filled sacs (cysts) or solid masses. Most thyroid nodules are benign (not cancer), but some are malignant (cancer).

The most common type of thyroid cancer in children is called papillary carcinoma. Children can also get other types of thyroid cancer, including follicular carcinoma of the thyroid and medullary carcinoma of the thyroid (MCT). MCT can run in families. Some children with thyroid cancer have another condition that runs in families called multiple endocrine neoplasia type 2 (MEN II). Read more.

Children with too much thyroid hormone (hyperthyroidism) may: 

• Be more nervous, agitated or emotional than usual
• Have trouble sleeping
• Lose weight even though they seem to be eating enough
• Sweat more than normal
• Have heart palpitations (flutters or skips in their heartbeat)
• Have high blood pressure
• Have diarrhea 

Overactive thyroid can make the thyroid get bigger. An enlarged thyroid is called a goiter. A goiter may be small and not cause any symptoms, or it may cause: 

• Swelling at the front of the neck, on both sides or only 1 side, that you can see or feel
• Pressure or tightness in the neck or throat if the goiter is very large. This might affect how your child swallows or breaths, cause coughing or make your child hoarse.

Children with too little thyroid hormone (hypothyroidism) may: 

• Seem sluggish or have low energy
• Be depressed
• Start gaining weight even though they have not changed their eating or exercise

Thyroid nodules do not usually cause symptoms. They may cause a lump in the neck that you, your child or a healthcare provider can feel. See information on thyroid cancer symptoms.

Overactive parathyroid glands can cause high levels of calcium in the blood, which can lead to these symptoms: 

• Feeling tired, weak and not well overall
• Having kidney stones
• Having headaches
• Being constipated

Blood tests can check the levels of thyroid hormones and antibodies that can affect how the thyroid works. The tests may include: 

• T3 resin uptake (T3RU)
• T3 total (triiodothyronine)
• T4 (thyroxine)
• Thyroid-stimulating hormone (TSH)
• Thyroglobulin antibodies (TgAb)
• Thyroid peroxidase antibodies

Imaging studies such as an ultrasound of your child’s neck allow doctors to see pictures of the inside of your child’s body. They can look at the size and texture of your child’s thyroid and check for nodules or other signs of disease.

If your child has a thyroid nodule or thyroid mass, they might need a biopsy. The purpose of a biopsy is to tell whether a nodule or mass is cancer (malignant) or not cancer (benign).

At Seattle Children’s, we use a biopsy method called fine-needle aspiration, done by our otolaryngologists. For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit and avoid the need for general anesthesia.

We numb the front of the neck using a needle-free device called a J-tip that pushes medicine (buffered lidocaine) into your child’s skin with a strong puff of air. Then we use a very thin needle (thinner than for a blood draw) to take a sample of cells. We use ultrasound to guide the needle to the right place.

The biopsy visit takes about 1 hour. We have results for you in about 1 week.

You and your child are in control — if your child feels too nervous about being awake during the biopsy, we schedule a biopsy under general anesthesia (so your child is unconscious) instead.

Medicines

For a child with too much thyroid hormone (hyperthyroidism), including Graves disease, doctors may prescribe a medicine to take by mouth every day to block thyroid activity. Common medicines for this are called propylthiouracil and methimazole. Or doctors may suggest treatment with radioactive iodine (radioiodine, or I-131) taken by mouth. The thyroid gland tends to take up, or concentrate, any iodine in the body. Then the radioactivity shrinks the thyroid, lowering the amount of hormone.

Surgery

A child with overactive thyroid may need surgery to remove the thyroid if any of these things happens: 

• The medicine doesn’t correct their hormone level.
• The medicine causes unwanted side effects or an allergic reaction.
• The child cannot have radioactive iodine because of their age or size.
• The thyroid has gotten too large.

For a child with too little thyroid hormone (hypothyroidism), including Hashimoto’s disease, doctors may prescribe pills of thyroid replacement hormone. This can keep the hormone level in the right range. Children taking these pills need to take them for life and see the doctor regularly. The doctor will check their hormone level and adjust their medicine as they age and grow.

A child with thyroid nodules that clearly are benign (not cancer) might have surgery to remove the nodules if they are large enough to cause problems, such as trouble swallowing or breathing. See how we treat thyroid cancer.

If you have been told that multiple endocrine neoplasia type 2 (MEN II) runs in your family, your doctor may suggest genetic testing and genetic counseling. This can help tell whether your child has MEN II and can give you information about your options. Children with MEN II nearly always get thyroid cancer, so families may choose to have the child’s thyroid removed early on — usually before age 5 — to prevent cancer from starting.

For 1 or more overactive parathyroid glands, surgeons may remove the glands causing the problem. There are 4 parathyroid glands near the thyroid. The body only needs 1 for normal function.

We work as a team, making sure you are connected with the specialists your child needs. Many children with thyroid problems see our endocrinologists, who are often able to treat the problem with medicine alone. If surgery is needed, our surgeons are experienced at performing thyroid surgeries in infants, children and teens. For children with thyroid cancer, Seattle Children’s oncologists offer the most advanced treatment options.

When we need to get a sample of tissue from your child’s thyroid, Seattle Children’s otolaryngologists perform fine-needle aspiration biopsies. This means we take a sample of cells using a very thin needle guided by ultrasound. It is not as invasive as cutting into the skin. For most children, we can do a physical exam and a fine-needle aspiration biopsy in the same clinic visit and avoid the need for general anesthesia.

Dr. Marguerite T. Parisi has been involved in many studies of radioactive iodine (radioiodine, or I-131) therapy, used for overactive thyroid.

Research on fine-needle aspiration biopsies for thyroid conditions shows our results for children and adolescents are as accurate as the results of doctors doing these biopsies for adults.

A study at Seattle Children’s showed our patients are ready to leave the hospital sooner after surgery to remove the thyroid. This is because of the ways we carefully manage low levels of calcium in the blood (hypocalcemia) — which can happen when surgery disturbs blood flow to the parathyroid glands.