Hashimoto’s thyroiditis in children

Although the autoimmune disease Hashimoto’s thyroiditis usually breaks out in adults, more and more children are affected by this autoimmune disease with the following hypothyroidism. But what are the characteristics and what should be considered?

Every mother and father will certainly care about, that their own child can develop healthy and grow up carefree. But if the child suffers from hypothyroidism of the thyroid gland, due to the autoimmune disease Hashimoto’s thyroiditis, the physical, mental and emotional development is often severely disturbed.

If the child’s thyroid gland is healthy, it forms the necessary hormones that every child needs for healthy development. These thyroid hormones are important for the development of the brain and have a positive influence on the heart function and the energy metabolism of the child.

Unfortunately, such endocrine disorders are becoming more common in children and adolescents. In this case, too few of the required hormones T3 (triiodothyronine) and T4 (thyroxine) are produced by the thyroid gland. The causes can be very different. However, it is important that children’s autoimmune disease Hashimoto’s thyroiditis is detected and treated as early as possible.

Hashimoto’s thyroiditis leads to hypothyroidism in children

Hashimoto’s thyroiditis is one of the most common causes of childhood hyperthyroidism. According to studies, about every 4,000 children are already born with an underactive thyroid gland. In other children, this hypofunction develops later due to the autoimmune disease Hashimoto’s thyroiditis. Here it is spoken of a congenital or of an acquired hypofunction of the thyroid gland.

The differences between congenital and acquired hypothyroidism:

  1. Congenital: The thyroid is either too small or not properly developed and trained or it is not even available.
  2. Acquired: Here the own immune system forms antibodies against the own tissue, so that it comes to an inflammation of the thyroid gland.

The actual causes of Hashimoto’s thyroiditis have not been fully explored. Genetic predispositions in children are probably as important as the influence of female hormones or increased or insufficient iodine intake, but also heavy metal and environmental toxins. This can all take place in the womb.

In general, the cause of Hashimoto’s thyroiditis disease in children is considered to be multifactorial. Also, it does not necessarily follow a particular pattern. But what is true, is the fact, that this autoimmune disease also depends on many factors in children. Environmental factors or even viral infections, as well as an acute selenium deficiency can be the trigger, as well as an increased or too low intake of iodine.

Note: Hepatitis C may also be the cause of the autoimmune disease Hashimoto’s thyroiditis.

Symptoms of childhood hypothyroidism

Hypothyroidism may be an important indicator of the autoimmune disease Hashimoto’s thyroiditis. Therefore, it is important for parents to know which symptoms this hypofunction can cause. Above all, overweight in teenage years, frequent fatigue and poor performance in school can be a clear signal for hypothyroidism. But also other symptoms may occur:

Typical symptoms in babies and newborns

  • Drinking laziness
  • Big fontanelle
  • Persistent or hardly disappearing jaundice
  • Hoarse cries, even if no cold exists
  • Puffy face
  • Reduced wines
  • Umbilical hernia
  • Apathy
  • Bloating
  • excessive sleep / decreased activity
  • Cold extremities
  • Constipation

Typical symptoms in young children

  • Delayed growth
  • Frequent and rapid freezing
  • Late teething or delayed tooth development
  • Common susceptibility to infections
  • Poor or sluggish speech
  • Conspicuous pale complexion
  • Late developer
  • Constipation and frequent abdominal pain
  • Low pulse
  • Dry skin
  • Fatigue

Typical symptoms in teens

  • Fatigue
  • Constipation
  • Hair loss
  • Anxiety and depression
  • Forgetfulness
  • Muscle weakness
  • Mood swings
  • Learning difficulties
  • Suddenly and unfounded performance drop in school
  • Concentration and memory problems
  • Often unfounded anxious and / or melancholic behavior
  • Late onset of puberty / period
  • Slowed breast development in girls
  • Sensitivity to cold
  • Inexplicable increase in body weight / obesity
  • Formation of edema in the eye area
  • Younger appearance than peers

Note: parents should note here that only one of these symptoms does not automatically suggest the autoimmune disease Hashimoto’s thyroiditis as the cause. Only a thorough examination, using laboratory data and thyroid ultrasound, can actually provide information about an autoimmune disease.

To avoid misdiagnosis, for example hyperthyroidism, as it often occurs at the beginning of a Hashimoto, can be confused with an Attention Deficit Hyperactivity Disorder (ADHD). Conversely, ADHD can be mistaken for hyperfunction, unless all necessary blood parameters are examined.

Diagnostic Procedures in Children with Hashimoto’s Thyroiditis

In order to diagnose the autoimmune disease Hashimoto’s thyroiditis in children, an examination will be performed after the consultation with the doctor, initially limited to palpation. Following this, a blood test will be initiated, taking into account other values ​​such as free T3 and free T4 besides the TSH value. Because only the TSH value is still no clear indication of the autoimmune disease. Rather, this value only says something about whether there may be a hypofunction of the thyroid gland.

Whether the TSH value is within the normal range, is decided by the physician, based on specific reference values ​​or reference ranges. The following table gives you a rough orientation as a mother or father, although the pediatrician will certainly give you enough information about it at any time.

The TSH reference in children and adolescents:

  levelsTSH reference value (μU / ml)
Age boy girl
3.5 years 1.0 – 5.6 1.0 – 4.7
4.0 years 1.0 – 5.6 1.0 – 4.8
4.5 years 1.0 – 5.6 1.0 – 4.8
5.0 years 1.0 – 5.6 1.0 – 4.9
5.5 years 1.0 – 5.6 1.0 – 5.0
6.0 years 1.0 – 5.6 1.0 – 5.1
6.5 years 1.0 – 5.5 1.0 – 5.2
7.0 years 1.0 – 5.5 1.0 – 5.3
7.5 years 1.0 – 5.5 1.0 – 5.3
8.0 years 1.0 – 5.4 1.0 – 5.3
8.5 years 1.0 – 5.4 1.0 – 5.3
9.0 years 1.0 – 5.3 1.0 – 5.3
9.5 years 1.0 – 5.3 0.9 – 5.3
10.0 years 1.0 – 5.2 0.9 – 5.2
10.5 years 0.9 – 5.1 0.9 – 5.1
11.0 years 0.9 – 5.1 0.9 – 5.0
11.5 years 0.9 – 5.0 0.8 – 4.9
12.0 years 0.9 – 4.9 0.8 – 4.8
12.5 years 0.9 – 4.9 0.8 – 4.7
13.0 years 0.9 – 4.8 0.8 – 4.5
13.5 years 0.9 – 4.7 0.7 – 4.4
14.0 years 0.8 – 4.6 0.7 – 4.3
14.5 years 0.8 – 4.5 0.7 – 4.2
15.0 years 0.8 – 4.4 0.7 – 4.2
15.5 years 0.8 – 4.3 0.7 – 4.1
16.0 years 0.8 – 4.2 0.6 – 4.0
16.5 years 0.8 – 4.1 0.6 – 4.0
17.0 years 0.7 – 4.0 0.6 – 4.0
17.5 years 0.7 – 3.9 0.6 – 3.9

Source: Robert Koch-Institut (2009) Population-related distribution values ​​of selected laboratory parameters from the study on the health of children and adolescents in Germany (KiGGS), series Federal Health Reporting, (Page 54-57,on 01/21/2019)

Update: The TSH reference for teens and adults have since been lowered and adjusted in most labs. A useful reference range is currently 0.2 – 2.5 μU / ml.

Also, the antibodies against thyroid peroxidase (anti-TPO) in the blood must be examined. These are typical inflammatory markers, which are usually significantly increased in a Hashimoto’s thyroiditis. Also antibodies to thyroglobulin (TAK) should be directly determined in the blood and belong to a proper diagnosis.

In addition to these diagnostic procedures, an experienced endocrinologist will also seek and evaluate thyroid changes by ultrasound (sonography).

Note: Because of the slower metabolism and the accompanying problems of the gastrointestinal tract, as they often occur in this autoimmune disease, also a massive nutrient deficiency is present, and the child should also be examined and treated in this regard.

How can Hashimoto’s thyroiditis be treated in children?

The diagnosis is the first step in the right direction. But in addition to the actual treatment, a complete causal research should be carried out for each affected child. Because only with the intake of hormone preparations, which should compensate the lack of thyroid hormone, the autoimmune disease is difficult to get under control. In this case, it is simply the symptoms that are being combated, not the cause itself.

Even though the research is not yet complete, there are indications of possible triggers that can cause Hashimoto’s thyroiditis in children.

These include:

  • Micronutrient depletion
  • Heavy metal contamination through vaccinations and dental amalgam
  • Leaky Gut due to poor and sugar-rich diet
  • Fungal diseases
  • Viral or bacterial infections

The intake of hormone preparations should begin as early as possible, especially in children. Because here development-specific features have to be considered. Usually, children also get L-thyroxine. This has a positive effect on the course of the disease. According to studies, this hormone therapy can have a stabilizing effect, so that a normal development of the child is possible.

How much L-thyroxine does my child need with Hashimoto’s thyroiditis?

According to a series of publications of the “Bayrische Landesapothekerkamme”r according to F. Dombeck and JC Böck, the following dosage recommendation with thyroxine results:

Ageabsolute maintenance dose
(μg / day)
relative maintenance dose / day
(μg / kg bw)
0 to 6 months25 to 5010 to 15
6 to 24 months50 to 758 to 10
2 to 10 years75 to 1254 to 6
10 to 16 years100 to 2003 to 4
> 16 years100 to 2002 to 3

Note: It always will be very important to remember that the trigger for Hashimoto’s thyroiditis should be treated simultaneously. As this cause is resolved or eliminated, the autoimmune disease may well retreat or its thrusts may be much lower and less severe.

Parents can also help treat their children by making sure their nutrition does not overfeed iodine. In addition, it will be important that the resulting deficiency symptoms are compensated by appropriate food supplements.

The deliberate intake of antioxidants such as zinc, selenium and vitamins A, C and E can also positively influence the course of the disease and effectively support hormone therapy. But also vitamin D3, iron, magnesium as well as vitamin B6 and vitamin B12 complex are also helpful components with which parents of affected children can actively contribute to the improvement of the disease.

Early detection and prevention is very important, especially in children

Whether there is indeed a hypofunction of the thyroid gland in childhood, is determined by the blood picture. Whilst newborns and toddlers can be diagnosed quickly through regular check-ups, this is often more difficult in older children.

So here are newborns clearly in the advantage. Because on them the TSH value is examined directly after the birth over the blood picture. If this is increased, the babies immediately receive an appropriate thyroid hormone. These children then usually develop completely normal.

Note: TSH stands for the thyroid stimulating hormone, released by the pituitary gland.

Thus, while newborns are automatically tested for hypothyroidism and thus an autoimmune disease such as Hashimoto’s thyroiditis can be detected and treated quite early, the whole thing is a little more difficult in older children. Especially in teenage years, it has to be remembered that many of the symptoms of thyroid disease may well point to the general hormonal changes during puberty.

For sure you will know that children and adolescents freeze faster at this age anyway, are often tired and lethargic or can also suffer from general weight problems. That is why it makes sense to have the TSH value determined even at this age. So better continue with the general check-ups even in adolescents. Because the “J1” automatically checks the thyroid gland and its values. In addition, it is normal for many adolescents that, due to the hormonal changes in the body, thyroid underfunctions may temporarily occur. If these remain within the limits or if there is no inflammatory disease of the thyroid gland, everything is in the green area. At least if the medical control remains.

Tip: A fairly clear indication of a malfunction or underactive thyroid gland is a so-called goiter. So if a teen has a thickening in the thyroid gland, the doctor should be consulted.

Image source:

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