Diffuse enlargement of the thyroid gland in adolescents. How to find out and what to do if a child has an enlarged thyroid gland

The thyroid gland is an organ of the endocrine system, without which the normal functioning of the body of any person is impossible. If a child has problems with the thyroid gland, then in this case there is a risk of developing dementia, poor academic performance, problems with the cardiovascular system, bone apparatus, and many other troubles. Such pathologies can lead to the fact that in the future the child will not be able to carry children normally, will suffer from nervousness and excess weight.

There are a huge number of reasons for the appearance of thyroid problems in children, but most often this occurs against the background. To exclude the development of pathologies, it is worth learning more about this organ of the endocrine system, as well as about its normal functioning.

Thyroid norms in children

If we talk about what the volume of this endocrine organ should be, then in babies under the age of 2 years, it cannot exceed 0.84 ml in volume. By the age of six, the indicators grow to 2.9 ml. With the onset of adolescence, the most rapid growth of the thyroid gland is observed. At the age of 13 to 15 years, the volume of the thyroid gland can be from 6.0 to 8.7 ml. By the age of 15, the volume of the thyroid gland in children can reach up to 11 ml. However, these figures only apply to boys.

In girls, the thyroid gland grows a little faster. By the age of 13, in young women, the volume of the thyroid gland can reach up to 9.5 ml. Upon reaching the age of fifteen, this figure increases to 12.4 ml.

If there is an increase in the norm of the thyroid gland in children, then this may be due to the peculiarity of the structure of the organism of a particular child. If the indicators begin to go beyond the permissible limits, then most often this indicates the development of a particular pathology. In this case, we can talk about both congenital diseases and acquired ailments. It is very important to identify problems in a timely manner and begin treatment.

First of all, it is necessary to diagnose and clarify the state of the hormonal background of the child. Also, the doctor should conduct an examination of the structure and volume of the thyroid gland. If a child has pathologies of the endocrine system at a young age, then, as a rule, the forecasts of doctors are positive.

Stages of thyroid enlargement

If the thyroid gland in children is in a normal state, then its presence is almost impossible to determine by touch. However, there is such a thing as the classification of the size of the goiter. In this case, we are talking about three stages of growth of the endocrine gland:

• Zero stage. In this case, there is practically no increase in the organ. On visual inspection, no changes are observed, however, during palpation, the gland may be slightly palpable. At the same time, its value should not exceed the size of the nail of the thumb.
• First stage. In the process, children noticeably noticeably increase. However, the external goiter still remains unchanged. The area where the organ is located will be slightly swollen.
• Third stage. In this case, the thyroid gland grows so much that a change in its dimensions becomes noticeable even with a visual examination, and it does not matter in what position the person holds his head. During palpation, the endocrine organ is very easily determined.

There is also another classification of goiter, which was created by Dr. O. V. Nikolaev. He singled out the zero degree, in which it is also impossible to note any changes in the size of the thyroid gland in children. This is followed by the first stage. In this case, the gland is also almost invisible, but on palpation, you can feel some error in the dimensions of the thyroid gland. He also adds a second degree. In this case, the gland will be clearly visible during visual inspection. It is easily palpable, but in this case the shape of the neck remains normal. At the third stage, the presence of pathology can be easily determined by the thickened neck. However, the patient will not complain of serious discomfort.

Nikolaev also identifies the fourth stage, during the development of which the neck begins to deform quite strongly. At the same time, the thyroid gland is clearly visible on it. In the fifth stage, the goiter becomes huge. This leads to severe discomfort. The body stops functioning normally. It also negatively affects the work of the digestive system and nearby organs. Patients complain that they cannot eat well, suffer from voice changes and increased shortness of breath.

How to determine the size of the thyroid gland?

When it comes to thyroid disease in children, it is very important to periodically conduct an independent examination of the child in order to identify certain abnormalities. For example, you can try to conduct an independent palpation. To do this, you need to feel each part of the endocrine organ and try to determine its structure. However, it is very difficult to cope with this without minimum skills. Only an endocrinologist can say for sure that children have a thyroid disease.

It is recommended to carry out. Based on the results of this procedure, it will be possible to say with higher accuracy about changes in the size of the thyroid gland. In some situations, x-rays and computed tomography are performed. Such methods are considered the most highly informative.

ultrasound

With the help of ultrasound, it is possible to determine with high accuracy the presence of pathology in the organ of the endocrine system. If the thyroid gland in children is normal, then in this case its shape will differ in even and clear contours. Even a “non-doctor” will not notice any enlarged lymph nodes that are in close proximity to the endocrine organ. Also, studying the results of the study, the specialist pays attention to the dimensions of the parathyroid glands. Their size should be about 4 x 5 x 5 mm. If even the slightest deviation is observed, then in this case the doctor will suspect the disease.

It is worth paying attention to the high body and its structure of heterogeneous form. In this case, experts most often suspect inflammation. The most alarming sign is seals. They may indicate that the child is suffering from a benign process or a malignant tumor.

If, thanks to ultrasound, the doctor has established that the thyroid gland has really increased and exceeds the norm, then in this case he most often diagnoses organ hyperplasia, or the so-called diffuse toxic goiter. If there is a decrease in the thyroid gland, then hypothyroidism is diagnosed. This indicates that the thyroid gland is not functioning properly. If a specialist has identified a hypofunction of the thyroid gland in children, then this indicates an improper production of hormones.

Depending on the clinical picture and the results of the research, the doctor may prescribe the appropriate treatment that will help to quickly cope with the problem.

Causes of possible pathologies

In order to understand the background of what a particular disease develops, it is first necessary to conduct a study and clarify the level of the three main hormones in the child's body. In this case, we are talking about thyrotropin, thyroxine and triiodothyronine. It is these hormones that are responsible for how quickly and efficiently all organs of the human body will form and grow.

Thyroid stimulating hormone is the most important. It stimulates the thyroid. However, sometimes there are failures in the production of this hormone. It is worth noting that not only the lack of certain components, but also their overabundance has a negative impact on the human body. Therefore, doctors must check the level of thyroid hormones in children.

If we talk about the main reasons due to which children may have problems with the thyroid gland, then most often diseases appear against the background of:

• bad ecology;
• the use of low-quality or genetically modified products;
• lack of iodine;
• development of cysts in the thyroid gland in children;
• failures in the work of the body's defense system;
• genetic predispositions;
• infectious diseases;
• viral infections;
• lack of selenium;
• injuries that the baby could receive in the process of birth.

Thyroid problems in children: symptoms

In this case, the pathology manifests itself identically, as in an adult. Parents of the baby must definitely pay attention to several clear signs that the endocrine organ is malfunctioning. First of all, there is a violation of the work of the heart. The rhythm becomes atypical. In order to determine this symptom, you can simply count the number of heartbeats per minute. If parents notice a too fast or, conversely, slow pulse, then you should immediately contact an endocrinologist and check the hormonal background of the child.

It is also worth looking at how the child looks and behaves. If he became lethargic, lethargic and began to speak slowly, then this may be a sign of problems. Many children have dry skin and frequent dermatitis. In some situations, such indicators also indicate poor-quality work of the thyroid gland.

Some children have a developmental delay. It becomes difficult for them to concentrate and study. There is a feeling that the child cannot remember even the most elementary things. If there were no such problems earlier, then it is quite possible that it is time to visit an endocrinologist.

Hypothyroidism - a pathology due to a lack of hormones

In this case, the child's body is deficient in hormones necessary for the full functioning of the thyroid gland. If this happens to a newborn, it is most likely that during pregnancy the baby's mother did not consume the required amount of iodine.

The danger of such a pathology is highest when it comes to a child under the age of 3 years. The fact is that during this period the baby begins to actively grow and develop mentally. If at such a moment he begins to suffer from such diseases, then this can negatively affect the whole process. After reaching the age of three, such pathologies are not able to lead to serious changes in the functioning of the central nervous system.

If a child suffers from congenital hypothyroidism, then, as a rule, he is born a little more weight than other babies. Often, childbirth is too long. Children may develop swelling of the face or jaundice, which is difficult to treat. If you do not start immediate treatment before the age of three, then after 3-5 months the baby will have complications. It will start to get worse. Unfortunately, if we are talking about congenital hypothyroidism, then treatment is not possible in this case. The only way out of the situation is to take the missing hormones throughout the rest of your life in order to restore balance in the system.

Hyperthyroidism - a pathology due to an excess of hormones

In this case, the situation is completely opposite. In the process of diagnosis, the child has an increase in the normal level of hormones. As a rule, children in adolescence suffer from such pathologies. If we talk about the symptoms, then the disease is very difficult to identify. And during this period there are numerous changes in the behavior of a teenager. If the child is emotionally unstable or suffers from increased physical activity, then this is worth paying attention to. If a teenager behaves irritably, eats poorly and is inattentive, then in this case there is a possibility of developing a pathology of the thyroid gland. Hyperthyroidism sometimes manifests itself in newborn babies. But it usually goes away on its own after a few months. The later the child encountered this pathology, the more difficult it will be to treat.

Thyroiditis is an inflammatory disease

This pathology develops against the background of processes in the autoimmune system, when antibodies begin to be produced in the body that attack the endocrine organ. This leads to severe inflammation. The child may be predisposed to this pathology against the background of heredity. However, severe stress can also provoke thyroiditis, when the body's protective functions begin to malfunction.

Nodes and tumors

Sometimes on the thyroid gland there are additional structures that differ from neighboring tissues in their density. Nodules in the thyroid gland in children can be a sign of both benign and malignant tumors.

If we talk about the main symptoms of a neoplasm, then you should pay attention to whether the child has problems when swallowing. If he complains of a so-called lump in his throat, then you should visit a doctor.

Treatment

The sooner the doctor can identify the pathology, the more successful the therapy will be. As a rule, in the treatment of the thyroid gland in children, drugs containing iodine are primarily used. The dosage of medicines and the scheme of their administration is developed by the doctor.

If a child is diagnosed with hypothyroidism, then in this case, hormonal drugs will be required. With hyperthyroidism, it is necessary to establish the work of the endocrine organ itself. With congenital pathologies, you can only stop unpleasant symptoms and prevent serious complications. It will not be possible to completely cure the thyroid gland.

It is not worth carrying out therapeutic measures at home without a preliminary examination by a specialist. Problems with the endocrine gland can quickly develop into a serious pathology. If the wrong treatment is prescribed, the child will lose precious time.

Iodine stimulates the production of hormones in the body. For children, this process is costly. Iodine deficiency is caused by its low content in soil, water and food. Lack of iodine is the main cause of any goiter.

Thyroid enlargement is the main manifestation of iodine deficiency. It can be of varying degrees. The volume of the gland depends on the age of the child and gradually increases as it grows.

This pathological condition of the thyroid gland has several varieties:

• Goiter with a properly functioning gland is euthyroid.
• Goiter with reduced production of hormones - hypothyroid.
• Goiter with increased production of hormones - diffuse toxic goiter.

In children, euthyroid and diffuse toxic goiter are most often diagnosed.

Euthyroid goiter is a condition of the thyroid gland in which the concentration of hormones is normal. Its cause is iodine deficiency. Such a goiter can be sporadic (when individual cases are identified) and endemic.

Girls are more prone to the appearance of euthyroid goiter. This is due to significant changes during puberty. After all, the need for this trace element at this time increases significantly.

Euthyroid goiter has two forms of development:

• parenchymal;
• colloidal.

In the parenchymal form, an increase in the gland occurs as a result of the body's reaction to iodine deficiency. The gland is made up of small follicles.

In colloid goiter, iron consists of large follicles. This goiter is characterized by stabilization of the production of thyroid-stimulating hormone.

Diffuse toxic goiter is characterized by an increase in hormones in the blood. Their excess negatively affects the work of many organs and systems. This pathological condition of the thyroid gland often accompanies puberty, puberty. Toxic goiter is characterized by an increase in metabolism, resulting in a decrease in body weight.

Common causes of goiter can be:

• frequent infections;
• disorder of pituitary functions;
• violation of the function of the sex glands;
• hypothermia;
• long-term use of medications that make it impossible for the absorption of iodine;
• diseases of the gastrointestinal tract, in which the process of absorption of iodine is difficult;
• nutritional imbalance;
• hereditary predisposition.

Symptoms

The main symptoms of goiter are the following:

• enlargement of the thyroid gland;
• attention disorder;
• disturbing shallow sleep;
• tearfulness;
• difficulty swallowing and breathing;
• fatigue, passivity, apathy;
• shortness of breath; unproductive cough;
• increase in heart rate;
• bilateral protrusion of the eyes;
• increased urine production;
• sudden change of mood;
• aggressiveness;
• excessive sweating;
• feeling of heat in the body;
• weight loss without loss of appetite;
• stool disorder;
• constant thirst.

Diagnosis of goiter in a child

The doctor - the endocrinologist is engaged in establishment of the diagnosis. He carries out the study of the anamnesis and examination, which includes a detailed external examination and palpation of the neck.

Assigns ultrasound diagnostics to establish the type of goiter. Radioisotope scanning of the gland allows you to evaluate the functionality of the organ. If there is a nodular form of goiter, then a mandatory study is a biopsy. Based on its result, the oncological nature of the disease will be revealed.

From laboratory tests, you will need a general blood and urine test, a blood test for hormones and thyroglobulin.

In most cases, the child has an imbalance of thyroid hormones and a high content of thyroglobulin.

Complications

Treatment of goiter should be carried out in a timely and adequate manner, because goiter is dangerous with the following complications:

• thyroid cancer;
• inflammation of the gland in an enlarged state - strumitis;
• hemorrhages in the thyroid gland;
• compression of the airways and other organs;
• the development of a "goiter" - a pathological process in which there is an increase in the right side of the heart.

Treatment

What can you do

Parents should organize a special diet based on foods high in iodine. These include: seafood and fish, seaweed, sea salt, cottage cheese, all kinds of nuts, dried fruits, berries, seeds of all kinds, honey, fresh vegetable and fruit juices.

What can a doctor do

Treatment of goiter in a child can be carried out by conservative and surgical methods. The basis of treatment is conservative therapy based on the use of thyroid drugs. The drugs are administered gradually, increasing the dosage over time.

If there is a slight enlargement of the gland, iodine therapy is necessary. An important condition for treatment is also a special diet.

Hypothyroid goiter requires hormone replacement therapy, i.e. the use of artificial analogues of hormones.

Surgical intervention is indicated for severe nodular goiter. This is expressed in a significant amount of goiter and compression of the respiratory tract and organs, resulting in difficulty breathing and swallowing. Children undergo resection of the thyroid gland. After the operation, hormone replacement therapy is performed to avoid relapses.

Prevention

Effective preventive measures include the regular use of table iodized salt and foods that are rich in iodine. You need to salt food at the end of cooking, because trace elements are sensitive to heat. The required daily dose of a microelement for a child under 7 years old is 90 mcg.

You should also take care of strengthening the immune system. For this, you need: general strengthening and hardening procedures, physical exercises, a balanced diet and the elimination of stress.

The first symptoms of thyroid disease in adolescents often go unnoticed, and the problem becomes noticeable when the disease moves to a more dangerous stage.

An annual dispensary examination by an endocrinologist helps to detect pathology at the very beginning of development and start treatment on time.

The thyroid gland is a miniature organ located in the neck, whose healthy weight barely reaches 30 g.

Throughout a person's life, it controls the metabolic processes in the body, the activity of tissues and organs.

The quality of the thyroid gland depends on a sufficient amount of iodine, which the body receives from food and water. For its work, iron uses about a third of the total amount of iodine contained in the body.

If the thyroid gland is enlarged in a teenager, this primarily indicates an iodine deficiency.

Features of the thyroid gland in adolescence

Adolescence, accompanied by the process of puberty, begins at about 11–12 years of age.

The thyroid gland in adolescents begins to work with increased activity in order to provide hormones to the growing body. At this time, the thyroid gland may also undergo external changes.

Important: Enlargement of the thyroid gland in adolescents is a fairly common occurrence. This is due to iodine starvation, when the body cannot provide for the increased functional needs of the gland.

Common symptoms of thyroid disease

Enlargement of the thyroid gland in adolescents does not occur from the first day of the disease. This process may be preceded by a long period.

Thyroid gland in adolescents

If the thyroid gland does not cope well with its duties, the symptoms in a teenager are of the following nature:

early sexual development or delay; growth retardation; dry skin; swelling; hair loss; discomfort and pain in the front of the neck; rapid heartbeat; frequent constipation or diarrhea; decreased concentration; nervous conditions; sleep disturbances; weight fluctuations.

Laboratory studies for thyroid diseases

It happens that the thyroid gland in a teenager is slightly enlarged, and it can be difficult to detect pathology by palpation.

Important! Symptoms cannot serve as the only confirmation of the disease.

To make an accurate diagnosis of thyroid disease in adolescents, an extended examination is carried out.

Laboratory methods

total triiodothyronine (T3); free triiodothyronine (T4); total thyroxine; free thyroxine; blood for thyroid stimulating hormone (TSH); antibodies to thyroglobulin (TG); antibodies to thyroperoxidase. ; biopsy; laryngoscopy.

Instrumental Methods

To diagnose thyroid disease in adolescents, only some types of examinations are required, which are prescribed after an external examination and palpation of the gland.

But it happens that the tests are normal, and the size of the thyroid gland exceeds the normal parameters.

Why is the thyroid gland enlarged in a teenager if the hormonal background is not disturbed? It turns out that the problem is the lack of iodine.

Thus, a protective reaction of the body to the deficiency of an important trace element is manifested.

Small thyroid gland what does it mean?

Thyroid disease in adolescence

The thyroid gland in adolescence must produce a certain amount of hormones. Their shortage or excess leads to the following diseases (ICD-10 / E00-E07 code):

Hypothyroidism

Low functionality of the thyroid gland, which is accompanied by a lack of thyroid hormones.

Symptoms of thyroid disease in teenagers

The cause may be congenital pathology, iodine deficiency, traumatic damage to the gland, autoimmune diseases.

blood pressure disorders, weight gain, weakness, dry skin, brittle nails, hair loss, frequent nasal congestion.

hyperthyroidism

This disease (diffuse toxic goiter) is diagnosed if thyroid hormones in adolescents are produced in excess. The disease has three stages of severity, depending on which symptoms appear.

The following signs indicate that the thyroid gland in adolescents produces an excessive amount of hormones:

increased irritability, excitability; rapid pulse, heart failure; impaired appetite; fatigue; muscle weakness; deterioration of nails, hair, skin.

Prevention and treatment of thyroid diseases

The thyroid gland in adolescence most often lacks iodine, so prevention is aimed at replenishing it.

A specialist can prescribe special dietary supplements and vitamin complexes, but the easiest way out is to replace ordinary salt with iodized salt and eat foods containing iodine: seaweed, fish, shrimp, boiled eggs, baked potatoes, cranberries, prunes.

In order for the thyroid gland in adolescence to be provided with the necessary amount of iodine, its daily dose should be 100 mcg per day.

If it is visually clearly visible that the thyroid gland in a teenager is enlarged, what should be done in this case?

Since the symptoms of insufficiency and excess production of hormones look about the same, it is not recommended to try to resolve the issue with iodine-containing drugs and products before testing for thyroid hormones and consulting a specialist.

Thyroid treatment in adolescents depends on the severity of the disease and the results of the examination.

It is aimed at restoring the functionality of the gland by taking drugs with iodine, hormone therapy. Teenage thyroid dysfunction is very treatable.

The relevance and significance of the problem of thyroid diseases in adolescents has existed for a long time. This is due both to the problem of iodine deficiency in the environment, which contributes to the development of a number of diseases, and to screening for congenital hypothyroidism.

The thyroid gland is one of the most important endocrine glands. Its importance is especially great for a growing, developing organism. The physiological role of thyroid hormones is diverse, it is aimed at almost all metabolic processes occurring in the body, the functions of most tissues and organs, including the processes of tissue differentiation, growth and development of the fetus, and the formation of the nervous system. Unlike adults, insufficiency of thyroid hormones in adolescence contributes to a sharp delay in the growth of the skeleton and the maturation of the central nervous system. Therefore, only timely and adequate treatment with thyroid hormone preparations provides a favorable prognosis for mental and physical development in adolescents and children with hypothyroidism. The success of hormone replacement therapy depends on the early diagnosis of diseases.

The classification of thyroid diseases in adolescents does not have any special distinguishing features from the classification for adults. Below is the nomenclature and clinical classification of diseases accompanied by changes in the thyroid gland:

Congenital anomalies of the thyroid gland: ectopia; hypoplasia and aplasia; non-closure of the lingual-thyroid duct. Endemic cretinism is subdivided according to the degree of enlargement of the thyroid gland; according to functional manifestations - hypothyroid, hyperthyroid, euthyroid; in form - nodular, diffuse, mixed. The division of sporadic goiter is the same as that of endemic goiter. Hyperthyroidism (diffuse toxic goiter) is divided according to the degree of enlargement of the thyroid gland; according to the severity of the course into severe, medium and light forms. Hypothyroidism is divided into: severe (myxedema), medium and light. Inflammatory diseases of the thyroid gland: acute (purulent, non-purulent), subacute and chronic thyroiditis (Hashimoto's lymphomatous and Riedel's fibrous). Damage to the tissue of the thyroid gland: closed, open. Malignant neoplasms of the thyroid gland: sarcoma, cancer, metastatic adenomas, etc.

Hypothyroidism is one of the most common thyroid disorders in adolescence. Moreover, it can be acquired or congenital, and according to the etiological factor - thyroid (primary), pituitary (secondary) and hypothalamic (tertiary). Hypothyroidism is a syndrome of complete or partial deficiency of the hormones thyroxine (T4) and triiodothyronine (T3). In some cases, the development of hypothyroidism syndrome is associated with a decrease in the action of these thyroid hormones on target tissues. In both cases, these disorders are accompanied by a decrease in all metabolic processes, fatigue, weakness, swelling of the face, drowsiness, reduced school performance, mood deterioration, the development of a depressive syndrome, anemia, and hyperlipidemia. In some cases, the above symptoms are not given due attention by adults, which is why the disease is diagnosed at later, more severe stages.

Clinical signs indicating the possibility of developing congenital hypothyroidism are: large fetal size (more than 3.5 kg), post-term pregnancy, constipation, edematous face, pale skin, female sex, muscle hypotension, macroglossia, psychomotor and physical developmental delay in children and adolescents, cretinism.

A very important medical and social problem for the youthful organism is iodine deficiency, which leads to the development of severe forms of hypothyroidism and is characterized by the presence of goiter. The main factor contributing to iodine deficiency in the human body is the low content of iodine in groundwater, soil, and food.

Lack of iodine contributes to the development of iodine deficiency diseases. According to the WHO definition, these include: short stature, goiter, mental retardation, deaf-mutism. In the presence of iodine deficiency in the body of a pregnant woman, the birth of children with various anomalies in the development of the thyroid gland is very common: congenital hypothyroidism, congenital malformations, with severe iodine deficiency - endemic cretinism (a combination of strabismus, deafness and mental retardation). Adolescents and children are characterized by a delay in mental and physical development, deterioration of intellectual and physical abilities, juvenile hypothyroidism, high morbidity, difficulties in schooling, and in adolescent girls - violations in the development of the reproductive system.

If a person lives in an area where there is a low level of iodine in food, drinking water, it is necessary to take preventive measures to avoid the development of a severe form of hypothyroidism. In doing so, it is necessary to focus on the following indicators:

Prepubertal children should receive 100 micrograms of iodine per day; Preschool children - 50 mcg per day; Lactating and pregnant women, as well as adolescents - 200 micrograms of iodine per day; Adult population - 150 micrograms of iodine per day.

In conclusion, we note that almost all thyroid diseases in adolescents and children respond very well to therapy and prevention. With timely diagnosis of thyroid diseases, they have a favorable prognosis, both in terms of maintaining health and in further social adaptation of children and adolescents. In connection with the foregoing, preventive monitoring of children and adolescents in all organized groups should be carried out on a regular basis.

Tags: thyroid gland

In pediatric endocrinology, thyroid diseases are extremely common. In some regions of our country, the incidence is quite high. The danger of these pathologies is that they can lead to the appearance of the most unfavorable clinical symptoms in the baby. Our article will talk about childhood hyperthyroidism.

What it is?

Hyperthyroidism is not a disease, but a pathological condition. It can lead to its appearance various thyroid diseases. An increase in the amount of peripheral thyroid hormones - T3 and T4 with a decrease in TSH (pituitary hormone) indicates the presence of thyrotoxicosis in the body. This pathological condition is often recorded in both children and adults. Boys get sick just as often as girls.

Healthy thyroid tissue is made up of numerous cells called thyrocytes. These powerful energy stations produce specific hormones that have a pronounced systemic effect on the entire body. Thyrocytes are grouped into special anatomical formations - follicles. Between neighboring follicles there are areas of connective tissue, in which nerves and blood vessels are located, which carry out the trophism of the thyroid gland.

Normally, peripheral thyroid hormones have a significant effect on the functioning of many internal organs. They affect the number of heartbeats per minute, help keep blood pressure within the age norm, participate in metabolism, affect mood and nervous activity. With age, the amount of peripheral hormones changes somewhat. This is due to the physiological characteristics of the human body.

Due to the active growth and development of the child, the level of peripheral hormones is quite high.

The reasons

Various pathological conditions lead to the development of increased production of peripheral thyroid hormones in a baby. Today, diseases of the thyroid gland in pediatric endocrinology significantly come to the fore. Their treatment is quite long and in some cases can last even several years.

The development of an increase in the blood level of T3 and T4 in a child is facilitated by:

• Diffuse toxic goiter or Graves' disease. This condition is characterized by a pronounced enlargement of the thyroid gland. In the development of the disease, heredity plays an active role. The disease proceeds with the appearance of pronounced metabolic systemic disorders. Diffuse enlargement of the thyroid gland contributes to an increase in the level of peripheral hormones in the blood.
• Nodular goiter. This disease is characterized by the appearance of dense patches in healthy thyroid tissue. Most often, this pathology is associated with the lack of a sufficient amount of iodine in the baby's diet. The disease is endemic, that is, it occurs in regions very remote from the sea. The first signs of the disease can develop in babies at the age of 6-7 years.
• congenital forms. This pathology is formed in the period of intrauterine development. This usually occurs during a complicated pregnancy in a woman who suffers from diffuse toxic goiter. According to statistics, 25% of babies born subsequently have signs of clinical or subclinical thyrotoxicosis.

• Injuries in the neck. Traumatic injuries of the cervical vertebrae contribute to mechanical damage to the thyroid gland tissue, which further contributes to the appearance of signs of thyrotoxicosis in the child.
• Neoplasms of the thyroid gland. Growing benign or malignant tumors contribute to disruption of the endocrine organ, which is accompanied by the appearance of clinical signs of thyrotoxicosis in the child.

The most common pathology that leads to the appearance of thyrotoxicosis in a child is diffuse toxic goiter. With this pathology, an increase in the size of the thyroid gland occurs. It may be subtle or it may be quite pronounced.

Endocrinologists distinguish several degrees of thyroid enlargement:

• 0 degree. It is characterized by the absence of any clinical and visible signs of goiter.
• 1 degree. The size of the goiter tissue exceeds the distal phalanx of the thumb of the baby who is being examined. On visual examination, no local enlargement of the thyroid gland is noted. Goiter elements are detected in the baby only during palpation.
• 2 degree. During visual inspection and palpation, the goiter is very well defined.

Symptoms

Disturbed work of the thyroid gland leads to the appearance of a variety of clinical signs in a sick child at once. Their expression may vary. With the active course of hyperthyroidism and a significant excess of peripheral hormones T3 and T4, the adverse symptoms of the disease are significantly pronounced.

In some cases, hyperthyroidism is practically not manifested clinically. This indicates the presence of a subclinical variant of the course. In this case, abnormalities in the functioning of the thyroid gland can only be detected during laboratory tests and the determination of peripheral hormones.

When a child has numerous adverse symptoms, doctors say that he has a clinical form of hyperthyroidism.

Among the most common clinical signs of the disease are the following:

• Rapid pulse or disturbances in the work of the heart. Often this is manifested by the appearance of an excessively accelerated pulse after minor physical or psycho-emotional conditions. With a pronounced course of hyperthyroidism, the heart rate also increases in a state of complete rest.
• Jumps in blood pressure. The systolic (upper) pressure usually rises. Diastolic (lower) in most cases remains within the normal range. These conditions characteristic of hyperthyroidism also contribute to an increase in pulse pressure.
• Behavior changes. The child becomes overly aggressive, easily excitable. Even a little criticism can contribute to a violent response. Typically, such mood swings are most pronounced in adolescents. Some children have real short bursts of anger.

• Tremor of the limbs. It is a classic sign of severe clinical hyperthyroidism. It is detected during a clinical examination by a doctor of any specialty. Tremor (shaking) of the hands is usually checked when the baby stretches both hands forward with the eyes closed. Usually hand trembling is small, not sweeping.
• eye symptoms. They manifest as exophthalmos (a slight protrusion of the eyeballs), too wide opening of the eyes, rare blinking, various convergence disorders (the ability to focus on objects) and other specific signs. The attending physician checks for these symptoms in a child during a clinical examination. Not only pediatric ophthalmologists, but also local pediatricians have the skills to determine these clinical signs in babies.
• Sleep disturbance. This symptom manifests itself in babies of different ages. Usually it is well manifested in children aged 3-7 years. The baby is very difficult to put to sleep, he often wakes up in the middle of the night. Often the child is disturbed by night noises that make him get up several times a night.

• Pathological elevation of mood. In some cases, a child with signs of thyrotoxicosis has spontaneous outbursts of intense joy and even euphoria. Usually such episodes are short-lived and may be replaced by pronounced aggressive behavior. The mood of the baby is leveled after the appointment of special medications.
• Marked pulsation in the vessels of the neck. This symptom is associated with changes in hemodynamics. An increase in pulse pressure leads to a strong blood filling of the main, as well as peripheral blood vessels. Usually this symptom is clearly visible on the vessels of the neck.
• Gastrointestinal Disorders. To a greater extent, in babies, this symptom manifests itself in the form of the appearance of frequent diarrhea. The child can go to the toilet several times a day. Prolonged diarrhea leads to various disturbances in metabolic processes and adversely affects the functioning of the entire digestive system.
• Increased appetite. A child with hyperthyroidism constantly wants to eat. Even if the child has eaten well at lunch or dinner, after a few hours he is again very hungry. The baby has a constant feeling of "wolf hunger". At the same time, the baby does not gain extra pounds at all, but, on the contrary, loses weight.

Diagnostics

If the parents have any suspicions that the child has signs of hyperthyroidism, you should definitely show the baby to the doctor. If possible, seek advice from a pediatric endocrinologist. This doctor will be able to carry out all the necessary set of diagnostic measures that will help establish the correct diagnosis.

Hyperthyroidism is easily diagnosed. To identify clinical forms, a detailed clinical examination is carried out, which includes mandatory palpation of the thyroid gland, as well as auscultation of the heart to detect cardiac disorders. After the examination, the doctor prescribes a series of laboratory tests that are needed to confirm the previously established diagnosis. These include the determination of peripheral thyroid hormones T3 and T4, as well as the quantitative measurement of the TSH hormone in the blood.

In hyperthyroidism, the content of T3 and T4 exceeds age norms, and the level of TSH decreases back.

To establish the clinical form of the disease, the doctor may additionally prescribe tests to detect specific antibodies to thyroid tissue. Usually this analysis is informative for establishing autoimmune pathologies of this endocrine organ.

To identify functional disorders, doctors also use additional diagnostic methods. They necessarily include an electrocardiogram of the heart. ECG allows you to identify any cardiac arrhythmias, manifested by sinus tachycardia or various forms of arrhythmias. To identify concomitant complications, the baby can also be sent for a consultation to a neurologist and an ophthalmologist.

• radioactive iodine. It is used for the ineffectiveness of early conservative treatment. The implementation of this technique is possible only in the conditions of special departments designed for radiotherapy. To normalize the condition and eliminate the clinical signs of hyperthyroidism, a course of treatment with radioactive iodine preparations is prescribed. The effectiveness of the method is quite high, however, in some cases, a recurrence of the disease is possible.
• Beta blockers. These medicines slow down the heart rate and restore normal heart function. They are prescribed for severe clinical hyperthyroidism and are used for course administration. With the improvement of well-being, drugs are canceled.
• Normalization of the daily routine. All babies with clinical signs of hyperthyroidism should avoid strong physical and psycho-emotional stress. Excessive workload at school can lead to a deterioration in the child's well-being and long-term preservation of signs of hyperthyroidism.

For information on what is hyperthyroidism in children, see the following video.

Diffuse thyrotoxic goiter is a severe endocrine disease characterized by an increase in the level of thyroid hormones in the blood. In toxic goiter (Basedow's disease), the thyroid gland produces hormones in response to stimulation of its receptors by specific antibodies that mimic the action of the pituitary stimulating hormone (TSH). With diffuse toxic goiter, a number of metabolic and neurological symptoms are observed. In this article we will consider the main points related to the problem of Basedow's disease in children.

What is the hypothalamic-pituitary system?

The higher centers of this system are located in the cerebral cortex and in the hypothalamus (a special center of the brain responsible for the functioning of internal organs). This is where information is stored and processed. Further, the signals are transmitted to a special endocrine gland - the pituitary gland, located at the base of the brain, whose task is to control other endocrine glands in our body. With the help of the hypothalamic-pituitary system, nerve signals and programs generated in the brain are converted into biochemical messages that are understandable to all cells of our body.

The work of the thyroid gland is also subordinate to the work of the hypothalamic-pituitary system: the pituitary gland controls the thyroid gland with the help of a specific hormone - TSH (thyroid-stimulating hormone). Having received a message in the form of molecules of this hormone, thyroid begins to produce its own hormones with a known energy-releasing effect.

What is diffuse toxic goiter? Why is this disease so called?

As we said above, the work of the thyroid gland is controlled by the TSH of the pituitary gland. However, this hormone controls not only the intensity of work, but also the growth of thyroid tissue.

Large amounts of the hormone lead to an increase in the size of the gland. This situation is observed, for example, in endemic goiter (one of the forms of hypothyroidism), when the size of the gland increases in response to a decrease in the amount of iodine entering the body (at the same time, few thyroid hormones are synthesized, which in turn leads to an increase in TSH levels and proliferation of thyroid tissues). glands).

In toxic diffuse goiter, the role of TSH is played by a certain type of antibody, one of the sections of which is very similar to TSH and therefore is perceived by the thyroid gland as a signal for growth and increased work.

A "diffuse" goiter is called if the entire gland increases at once, and not its individual sections.

The term "toxic goiter" is used to refer to the effect of the disease on the metabolism of the body of a sick person. The effects of the disease, to a certain extent, resemble the symptoms of poisoning (toxin - poison).

Diffuse toxic goiter is also called Graves' disease by the name of the doctor who first described it in detail.

Who suffers from diffuse toxic goiter?

What happens with diffuse toxic goiter? What is the cause of the disease?

This question can only be answered by looking inside the mechanisms of the development of the disease itself and the processes of controlling the thyroid gland. Diffuse toxic goiter is an autoimmune disease, that is, a disease caused by an attack on the body of its own immune system. With Basedow's disease, this "attack" is very specific: the cells of the immune system begin to produce antibodies that can bind to the cells of the thyroid gland, which perceives this as receiving a signal in the form of TSH (see above) and begins to work actively.

Such a violation of the body's own immune system may be genetically determined.

How is the disease progressing? What are its main symptoms?

Neurohormonal stage - there are pronounced symptoms of poisoning with thyroid hormones (thyrotoxicosis); the thyroid gland is markedly enlarged (goiter).

Visceropathic stage - a prolonged increase in the level of thyroid hormones leads to changes in the internal organs.

Cachectic stage - characterized by complete depletion of the body.
The main symptoms of the disease can be divided into the following categories:

Neurological symptoms: patients with Graves' disease show severe irritability, agitation, complain of insomnia. A frequent symptom of the disease is trembling: trembling of outstretched hands and fingers, trembling of the whole body in a standing position, trembling of closed eyelids.

Symptoms from the cardiovascular system: one of the symptoms of thyrotoxicosis is a persistent increase in heart rate (up to 180 per minute!) And increased blood pressure, due to the increased work of the heart on the arteries, a strong pulse is felt, the pulsation of the cervical arteries becomes noticeable. Often, patients with Basedow's disease complain of shortness of breath and palpitations during physical exertion.

Symptoms from the gastrointestinal tract - against the background of diffuse toxic goiter, persistent diarrhea or constipation may develop. Children with this disease eat a lot, but despite this, they lose weight.

Ocular symptoms of Graves' disease: The ocular symptoms of Graves' disease are considered to be its classic features. In children with diffuse toxic goiter, the following symptoms can be noted: wide opening of the eyelids, no narrowing of the palpebral fissure with laughter or other emotions, rare blinking of the eyes, trembling when the eyelids are closed, "glitter in the eyes", pigmentation (darkening) of the skin of the eyelids, swelling of the eyelids, unevenly dilated pupils.

What is a thyroid crisis?

The symptoms of a crisis are as follows: a sharp increase in body temperature up to 40 C, a pronounced increase in heart rate up to 200 beats per minute, increased arousal, and then apathy and drowsiness of the patient, vomiting, nausea, diarrhea. Thyrotoxic crisis is an extremely dangerous condition that requires immediate medical attention.

How is diffuse thyrotoxic goiter diagnosed?

The diagnosis of the disease is established on the basis of: symptoms and clinical signs of the disease, data on the development of the disease provided to patients, information obtained during the examination of the patient (for example, an enlarged thyroid gland), as well as laboratory methods for examining the patient.

The main method of laboratory diagnosis of thyrotoxicosis is the determination of the concentration of thyroid hormones (T3 and T4), as well as pituitary hormone (TSH).

An ultrasound examination (ultrasound) may be needed to determine the size and structure of the thyroid gland.

To confirm the diagnosis of Graves' disease, the determination of antibodies that stimulate the thyroid gland is carried out.

How is diffuse toxic goiter treated in children?

What is the drug treatment of thyrotoxic goiter and how is it carried out?
Medicinal treatment of Graves' disease is carried out with drugs that inhibit the functioning of the thyroid gland, thyreostatics (for example, Thiamazole). The duration of treatment and the dosage of the drug are determined by the attending physician individually for each patient. The average duration of treatment for mild forms of the disease can be six months, and for severe forms 5 years. One of the side effects of drug treatment may be the inhibition of hematopoiesis, therefore, during the course of treatment, it is recommended to systematically monitor the composition of the blood.

When is surgical treatment of Graves' disease prescribed?
Surgical treatment of diffuse toxic goiter involves the removal of most of the thyroid gland, so that the remaining part secretes hormones in an amount sufficient for the normal functioning of the body.

Surgical treatment is a last resort. The need for such treatment may arise in the following cases:
Large goiter, compression of the neck organs by the thyroid gland;

The presence of active (“hot”) nodes in the thyroid gland;

Relapse of the disease after a full course of treatment;

The location of the goiter behind the sternum or elsewhere (ectopia of the thyroid gland);

Intolerance to drug treatment or severe inhibition of hematopoiesis against the background of ongoing treatment.

Bibliography:
1. G.F. Aleksandrova, Clinical endocrinology: A guide for doctors, M.: Medicine, 1991
2. Abramova N.A. Endocrinology, M. : GEOTAR-Media, 2008