Neglected conditions - Congenital and Juvenile Hypothyroidism explained by Dr. Nikhil A Shah

Dr. Nikhil A Shah talks about how important it is to identify congenital and juvenile hypothyroidism and how we can escape from major health conditions like intellectual disability or mental retardation of the kids by doing so. He recommends a national policy for thyroid tests to be made mandatory in the first week of a child’s life.

Thyroid is an important gland, and problems with this gland may be more common than we may think. Thyroid disorders can affect anyone at any age, including children and newborns. To spread awareness about thyroid disorders, Medicircle is speaking to eminent doctors so that people can manage their as well as their children’s condition well.

Dr. Nikhil A Shah Is a Pediatric Endocrinologist & Child and Adolescent Growth Specialist who specializes in children with short stature, type 1 diabetes, early or delayed puberty, obesity, thyroid disorders, and various other endocrine disorders. He is associated with the Doctor’s Hub, Cloudnine Hospital, Neoplus Hospital, Royal Children Hospital, and Smiles N Giggles, Mumbai. He has 15 indexed publications and one textbook chapter and many presentations in state, national and international conferences to his credit.

Hyperthyroidism and Hypothyroidism

Dr. Nikhil mentions, “When we talk of thyroid disorders, there is a type of thyroid disorder when the thyroid levels are low, which we call hypothyroidism. There is also a group of disorders where the thyroid levels are more and it is called hyperthyroidism. Hypothyroidism is very common. Hyperthyroidism is rare. The most common cause of hyperthyroidism in children is an autoimmune form called Graves’ disease, where the body acts against the thyroid gland to increase the thyroid hormones.”

Congenital and juvenile hypothyroidism

Dr. Nikhil explains, “In children, hypothyroidism is seen in two age groups. One is right from birth which is known as congenital hypothyroidism. The other one is juvenile hypothyroidism which gets evident after two years of age. Congenital hypothyroidism does not get easily picked up. Parents of newborns need to know about congenital hypothyroidism. It is either a structural defect which means there is some problem in the structure of the gland or there is a functional defect. Structural defects are called dysgenesis. So either the gland is not there at all or it is at another place called the ectopic gland, or the size of the gland is very small. These are the most common causes of congenital hypothyroidism. Functional defects occur when the process of the formation of hormones gets affected. This constitutes about 10 to 20% of the causes of hypothyroidism. 

There is no way to prevent congenital hypothyroidism. Juvenile hypothyroidism is mostly acquired hypothyroid. The most common causes of acquired hypothyroidism are autoimmune conditions - when the body starts acting against itself and destroys the thyroid gland,” says Dr. Nikhil.

Identifying congenital hypothyroidism means preventing intellectual disability or mental retardation in children

Dr. Nikhil points out, “Congenital hypothyroidism is the most preventable measure for intellectual disability or mental retardation in children. The problem with congenital hypothyroidism is that there are no clinical signs and symptoms where you can identify the condition. So, there should be a newborn screening program in place. In places like the US and UK, there is a national newborn screening program in which they undergo a thyroid test. In India, unfortunately, this thyroid screening program is present only in a couple of states. There is no national policy as such. Certain private institutes are practicing it so what I would advise to all parents or any caregivers is that before getting discharged from the hospital, there should be thyroid hormone check of the newborns.

This can be done either from the cord blood level or from the heel prick through which blood samples are taken and sent for investigations. If it shows signs of hypothyroidism then there would be further evaluations to ascertain hypothyroidism and prevent conditions like mental retardation. All children should undergo a thyroid test, especially in the first week of life,” recommends Dr. Nikhil.

Effects of hypothyroidism in newborns if they are left unidentified

Dr. Nikhil informs, “The cry of the newborn will change, it will become hoarse. There will be some sort of lethargy. The mother will complain that the child is not feeding well. The newborns have two soft spots /openings on the head. One is the anterior fontanelle and the other is the posterior fontanelle. The posterior opening usually closes by three months of age. If the posterior fontanelle is very large and is not closing by three months, there could be hypothyroidism. Other symptoms could be dry skin, coarse face, enlarged tongue, large umbilical hernia etc.”

Effects of hypothyroidism in older children if they are left unidentified

Dr. Nikhil mentions, “The most common effects on older children would be that they would not  grow in height and would keep putting on weight. Other signs could be periorbital puffiness, the lips would be swelled up. The parents of such children commonly say that “the child has suddenly become very dull. He was very active and good at studies but now he doesn't respond to anything, he just prefers sitting in one place.” These children also feel very cold. So these are the ways in which hypothyroidism manifests in older children if left unidentified.

A simple tablet and regular monitoring is the treatment

Dr. Nikhil informs, “Whether it is congenital hypothyroidism or acquired / juvenile hypothyroidism, the only treatment is a simple tablet. We need to give the tablet daily. In newborns, the tablet needs to be mixed with milk. It has to be given early in the morning. In newborns, it is difficult to give the tablet in fasting. But in older children, we ask them to delay breakfast or delay drinking water for at least by half an hour. This is how we continue with the treatment. Sometimes hypothyroidism can be transient so we can stop the medications but in most cases, if the correct diagnosis is made, they would require lifelong medications. In the first three years of life, monitoring should be at fixed intervals as entire brain development is dependent on the thyroid hormone. Monitoring is very important at this stage. Once the child is more than three years of age, we monitor it every six months. And as the child grows older, and puberty is complete then monitoring once a year is ok,” says Dr. Nikhil. 

Are children with hypothyroidism or any other thyroid disorder at the risk of developing COVID-19?

Dr. Nikhil reples, “I would say''no”. Even the European Society has released a statement saying that children who are having hypothyroidism are not at risk of developing COVID-19. But it is important to understand that children with uncontrolled hypothyroidism are at the risk of developing any infection. So if they are at risk of developing any infection, they can develop COVID-19 as well. Hence, it is necessary to maintain the thyroid levels in the right range. Another important thing to note is that because of COVID-19, all other chronic disorders in children are being ignored. So, I would urge parents that though it is very difficult to step out of the house in these times but at least if you could do a phone consultation particularly if your child is in the middle of the treatment of something then it would be nice as doctors would accordingly be able to guide with change in doses, etc,” advises Dr. Nikhil.

(Edited by Amrita Priya)




Contributed By: Dr. Nikhil A Shah, Consultant Pediatric Endocrinologist & Child and Adolescent Growth Specialist
Tags : #World-Thyroid-Day-Awareness-Series #DrNikhilAShah #cloudninehospital #doctorshub #smilesngiggles #neoplushospital #royalchildrenhospital #congenitalhypothyroidism #juvenilehypothyroidism #thyroidtest #hypothyroidisminnewborns #hypothyroidisminchildren #smitakumar #medicircle

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