When the body can't produce an adequate supply of hormones, it can cause health problems. This is where hormone replacement therapy plays an important role.

Hormone replacement therapy typically involves the use of synthetic thyroid hormones, such as levothyroxine, to restore the body's hormonal balance. In most cases, this effectively alleviates the symptoms of hypothyroidism and enhances the overall quality of life for affected individuals.

Before we delve deeper into how thyroid hormone replacement therapy treats acquired hypothyroidism, we should establish a background on what this condition actually is. Let's dive right in!

What is Acquired Hypothyroidism?

Acquired hypothyroidism, as the name suggests, refers to a thyroid disorder that develops later in life, distinct from congenital hypothyroidism, which presents from birth. At its core, hypothyroidism is characterized by an insufficient production of thyroid hormones within the body, leading to a cascade of adverse health effects.

In contrast, congenital hypothyroidism is diagnosed within the first couple of months of life. An infant with congenital hypothyroidism also has low levels of thyroid hormone but the causes are distinct from acquired hypothyroidism. Please click the link in this paragraph to learn more.

Causes of Acquired Hypothyroidism

Understanding the causes of acquired hypothyroidism is key to not only recognizing the condition but also to crafting effective treatment plans. Here, we delve into the primary factors contributing to this thyroid disorder:

Autoimmune Hypothyroidism (Hashimoto's Thyroiditis)

Hashimoto's thyroiditis, the most common cause of acquired hypothyroidism, is an autoimmune disorder. In this condition, the body's immune system erroneously identifies the thyroid gland as foreign and launches an attack against it.

Over time, this damages and eventually destroys the thyroid tissue, leading to a reduction in thyroid hormone production. The nature of Hashimoto's often means that symptoms develop gradually, making early diagnosis crucial for effective management.

Iodine Deficiency

Iodine, an essential mineral, plays a pivotal role in the synthesis of thyroid hormones. When the body lacks an adequate supply of iodine, it struggles to produce sufficient thyroid hormones.

This deficiency can be a result of a diet low in iodine-rich foods or living in regions where iodine is scarce in the environment. It underscores the importance of maintaining a balanced diet and, in some cases, taking iodine supplements to prevent iodine deficiency-related hypothyroidism.

Iatrogenic Causes

Iatrogenic hypothyroidism occurs as a consequence of medical treatments, often related to procedures or interventions involving the thyroid gland. These causes include:

• Thyroid Surgery or Radiation: Surgical removal of the thyroid gland, called thyroidectomy, or exposure to radiation therapy in the neck area can lead to hypothyroidism. These treatments are typically employed to address conditions like thyroid cancer or hyperthyroidism and lead to reduced thyroid function or hypothyroidism.
• Iodine-Containing Contrast Agents: Iodine-containing contrast agents, used in various medical imaging procedures, can temporarily affect thyroid function.

Who is at risk for developing acquired hypothyroidism?

Acquired hypothyroidism poses a risk to various individuals, particularly those with specific factors and conditions:

• Family History of Autoimmune Diseases: A genetic predisposition to autoimmune thyroid disorders increases the risk.
• Celiac Disease: Co-occurrence of celiac disease and hypothyroidism is more likely.
• Coexisting Autoimmune Conditions: Conditions like Type 1 Diabetes and Addison's disease elevate the risk due to shared autoimmune mechanisms.
• Gender Variation: Acquired hypothyroidism is more common in girls.
• Iodine-Deficient Diet: Relying solely on iodine-depleted sea salt can lead to iodine deficiency and, subsequently, hypothyroidism.
• Thyroid Cancer History: Previous thyroid cancer, requiring gland removal, may lead to acquired hypothyroidism and necessitate hormone replacement therapy.
• Iodinated Contrast Exposure: In children, iodinated contrast agent exposure during medical imaging can temporarily disrupt thyroid function.

Understanding these risk factors helps with early identification and personalized management of acquired hypothyroidism, emphasizing the importance of tailored healthcare for those at higher risk.

Symptoms of Hypothyroidism in Children

• Feeling tired
• Constipation
• Poor growth
• Weight gain
• Goiter or enlarged thyroid gland
• Dry skin
• Feeling cold
• Decreased metabolism
• Delays in puberty
• Abnormal lipid panel
• Muscle aches
• Delayed milestones

How is Hypothyroidism Diagnosed?

Diagnosing acquired hypothyroidism involves blood tests to measure TSH and T4 levels, along with clinical symptom evaluation and medical history assessment.

Once confirmed, treatment, typically involving thyroid hormone replacement therapy, is tailored to restore hormonal balance and alleviate symptoms. Early diagnosis and ongoing monitoring are essential to prevent complications.

How is it Treated?

Hormone replacement therapy is the cornerstone of treatment for acquired hypothyroidism. This therapy involves the administration of synthetic thyroid hormones, such as levothyroxine, to compensate for the inadequate hormone production by the thyroid gland.

By restoring normal hormone levels, this treatment alleviates the distressing symptoms of hypothyroidism, such as fatigue, weight gain, or growth failure. The therapy is precisely tailored to each patient's needs, emphasizing the importance of regular monitoring and dosage adjustments.

The Role of Levothyroxine (T4) in Hypothyroidism Treatment

The primary approach for addressing persistent or severe hypothyroidism hinges on thyroid hormone replacement therapy. This treatment involves the administration of levothyroxine or T4 in tablet form, and it is the most commonly prescribed therapy for hypothyroidism.

Remarkably, the majority of individuals with this condition experience substantial improvement in both their blood thyroid levels and the alleviation of their symptoms through this treatment. For instance, in the case of children facing growth issues due to insufficient thyroid hormone, growth rates typically rebound and normalize with the initiation of treatment.

Levothyroxine plays a vital role in restoring thyroid function and enhancing the overall well-being of those affected by hypothyroidism.

The Role of Liothyronine (LT3) in Thyroid Therapy

While LT3, or liothyronine, has been explored in the context of thyroid therapy, it has not demonstrated superiority over the conventional treatment with levothyroxine. This is because the human body converts T4 to T3, the biologically active form of thyroid hormone, which is usually sufficient for most individuals.

However, in cases where some continue to experience symptoms despite standard replacement therapy or have difficulty converting an adequate amount of T4 to T3, supplementation with liothyronine may be considered.

It's worth noting that research on this medication has primarily focused on adults, and its use in children is less common. Liothyronine can be administered in precise doses, distinguishing it from desiccated thyroid or thyroid extract, which is not recommended for pediatric use.

Results of Treatment

After starting thyroid hormone replacement therapy, routine lab monitoring typically occurs approximately 6-8 weeks from the start of treatment. However, there are specific situations where more frequent lab assessments might be recommended and based on individual needs.

This close monitoring is essential for fine-tuning the treatment plan and ensuring its effectiveness. Importantly, beyond the laboratory values, there may also be observable improvements in various symptoms associated with low thyroid levels.

These positive changes can manifest in enhanced energy levels, normalized growth parameters, or more favorable cholesterol levels. This provides further evidence of the treatment's effectiveness in optimizing thyroid function and overall well-being.

How to Live With Acquired Hypothyroidism

Once hypothyroidism is effectively treated, individuals can expect favorable outcomes. However, consistent adherence to prescribed medication is paramount.

It's advisable to establish a daily routine for taking medication, typically on an empty stomach, and separate from other medications or meals. Complementing medication management, maintaining a well-balanced diet, engaging in regular exercise, and ensuring restful sleep all contribute to healthier results.

Periodic lab evaluations are necessary and their frequency varies with age and also are guided by symptoms. Children and adolescents may require more frequent monitoring due to specific considerations.

Get Expert Advice from an Experienced Professional

If you or your child are at risk or exhibit symptoms of hypothyroidism, seeking expert evaluation and care from a board-certified Pediatric Endocrinologist is essential.

Every parent wants their kid to be healthy, but it can be hard to spot the signs or notice when something is a little bit off with your child. Whether it is a common cold or something more serious, you want to be at the forefront of the problem to catch and treat the illness early. So, when it comes to hypothyroidism in kids, you need to be educated on what you’re looking for.

While it may seem daunting, arming yourself with knowledge is the first step in navigating this journey. We'll walk you through what hypothyroidism is, how to recognize its signs and symptoms, the different types, and most importantly, how to manage and support your child if they are diagnosed with this condition.

Let’s get started.

Is Hypothyroidism in Kids Common?

Before we dive deeper into the intricacies of pediatric hypothyroidism, let's address a pressing question: just how common is this condition among children? It's a question that often lingers in the minds of concerned parents, and rightfully so.

While autoimmune hypothyroidism is more frequently seen in adults, it's essential to recognize that children can also be affected.  It is estimated that about  1-2% of children have hashimoto’s thyroid disease.  There are also several other less common causes of hypothyroidism, some of which are discussed below.

Congenital Hypothyroidism

Congenital hypothyroidism, or CH, is a condition that a child is born with. The root causes of congenital hypothyroidism are typically related to abnormal development  of the thyroid gland itself. 

The exact prevalence varies across different regions and populations, but on a global scale, it is estimated that approximately 1 in 2,000 to 1 in 4,000 infants may be affected.

The most common cause is a failure of the thyroid gland to develop correctly during fetal development, known as thyroid dysgenesis. Less frequently, it can also result from defects in thyroid hormone synthesis or an inherited genetic condition that affects thyroid function. 

While congenital hypothyroidism can present, on average, in 1 in 3000 infants, early detection through newborn screening programs has been instrumental in ensuring timely diagnosis and treatment as this leads to a good prognosis.

Acquired Hypothyroidism

On the other hand, acquired hypothyroidism is more likely to develop after the first year of life and can manifest at any point of childhood or adolescence. The leading cause of acquired hypothyroidism in children is an autoimmune condition called Hashimoto's thyroiditis, wherein the body's immune system mistakenly attacks and damages the thyroid gland. 

Other potential causes of acquired hypothyroidism in children may include certain medications, radiation therapy, or surgical removal of the thyroid gland (thyroidectomy). Additionally, iodine deficiency, though rare in many developed countries due to dietary supplementation, can lead to acquired hypothyroidism if untreated.

What Does the Thyroid Do?

Before delving into the specifics of thyroid problems and their impact on children, it's crucial to grasp the thyroid's fundamental role in the body.

The thyroid gland, located in the front of the neck, is a small but mighty organ with a big responsibility: it regulates the body's metabolism. It does so by producing two critical hormones, thyroxine (T4) and triiodothyronine (T3), which play a central role in influencing how cells use energy and in the overall functioning of the body.

In growing children, the thyroid is especially essential. Thyroid hormones are like the body's metabolic conductors, orchestrating a symphony of processes that support physical and mental growth. They impact everything from the development of the brain and nervous system to the growth of bones and muscles.

Potential Effects of Thyroid Problems on Child Development

Thyroid problems, particularly hypothyroidism, can cast a shadow over a child's life, affecting various aspects of their physical and cognitive development. Let's take a closer look at the potential consequences.

Slower Growth

One of the most noticeable effects of untreated hypothyroidism in children is slower growth. The thyroid hormones are essential for the growth and development of bones and muscles. When these hormones are deficient, children may exhibit stunted growth compared to their peers. 

Parents and caregivers might notice that their child isn't reaching typical height and weight milestones or that they are consistently shorter than other kids their age.

Lack of Activity

Fatigue and lethargy are common symptoms of hypothyroidism in children. As a result, affected kids may lack the energy and motivation to participate in physical activities and play like other children. This reduced activity can not only hinder their physical development but may also affect their social interactions and overall quality of life.

Poor School Performance

Thyroid hormones are crucial for brain development and cognitive function. When a child's thyroid is underactive, it can lead to memory problems, and a possible decline in school performance. Children with untreated hypothyroidism may struggle with academic tasks, leading to frustration and a decline in self-esteem.

Symptoms of Hypothyroidism in Kids

Here are some common signs of hypothyroidism in kids. It's important to remember that not all children with hypothyroidism will experience every symptom, and the severity of symptoms can vary. 

• Fatigue and Lethargy
• Weight Gain
• Dry Skin
• Slowed Growth
• Constipation
• Cold Intolerance
• Puffy Face
• Hoarse Voice
• Slow Heart Rate
• Hair Changes
• Delayed Puberty (in adolescents)
• Memory and Concentration Issues
• Mood Changes
• Muscle Weakness
• Joint Pain
• Menstrual Irregularities (in adolescent girls)

If you notice any of these signs in your child, especially if they persist or worsen over time, it's advisable to consult a pediatric endocrinologist for a thorough evaluation and diagnosis.

Types of Hypothyroidism

Hypothyroidism in kids and adults can form in different ways, and understanding the differences is essential for proper diagnosis and management. Let’s go over the different types.

Autoimmune Hypothyroidism

Autoimmune hypothyroidism, also known as Hashimoto's thyroiditis, is the most common cause of acquired hypothyroidism in kids. It occurs when the body's immune system mistakenly attacks the thyroid gland, leading to inflammation and damage.

Causes: The exact cause of autoimmune hypothyroidism is not fully understood, but it is believed to have a genetic disposition.  As having a family history of autoimmune thyroid disorders can increase a child's risk.

Symptoms: Symptoms are similar to those of other forms of hypothyroidism and may include fatigue, weight gain, dry skin, and poor school performance.

Iatrogenic Hypothyroidism

Iatrogenic hypothyroidism refers to hypothyroidism that is induced by medical treatment, often involving the use of certain medications or surgical procedures.

Causes: This type of hypothyroidism can be caused by the surgical removal of the thyroid gland (thyroidectomy) or as a side effect of certain medications, such as those used to treat hyperthyroidism.

Symptoms: Iatrogenic hypothyroidism presents with typical hypothyroid symptoms and may require lifelong thyroid hormone replacement therapy in particular, those who had their thyroid gland removed.

Central Hypothyroidism

Central hypothyroidism, also known as secondary or tertiary hypothyroidism, is a less common form of hypothyroidism in children. It arises when there is an issue with the pituitary gland or the hypothalamus in the brain, which are responsible for regulating thyroid hormone production.

Causes: Central hypothyroidism can be congenital (present from birth) or acquired due to tumors, radiation, or other damage to the pituitary or hypothalamus.

Symptoms: Symptoms may vary and can include growth delay, delayed puberty, and fatigue. Because it involves dysfunction in the brain's signaling, the presentation may differ from typical hypothyroidism.

Each type of hypothyroidism in children requires a tailored approach to diagnosis and treatment. In all cases, early detection and management are crucial to mitigating the impact on a child's growth, development, and overall well-being.

Treating Hypothyroidism in Kids

Hormone replacement therapy is the primary treatment for hypothyroidism in kids. Since the thyroid gland isn't producing sufficient thyroid hormones, synthetic thyroid hormone medication, such as levothyroxine, is prescribed. The dosage is carefully adjusted aiming to restore thyroid hormone levels to normal. 

This treatment is usually lifelong, and regular monitoring through blood tests is essential to ensure the child receives the correct dose. With prompt diagnosis and appropriate treatment, children with hypothyroidism can lead healthy, fulfilling lives, with their growth, development, and overall health fully supported by maintaining optimal thyroid hormone levels.

Give Your Child the Treatment They Deserve

Now that we’ve discussed the signs and symptoms that parents should be vigilant about, it should be easy to understand the importance of early detection and intervention. Remember, if you suspect your child may be experiencing symptoms of hypothyroidism or if you have questions and concerns, you don't have to navigate this journey alone.  Expert guidance can make all the difference in your child's health and well-being, and pediatric endocrinologist Dr. McIver is here to help.

Euthyroid sick syndrome, or ESS, is a state in which the thyroid hormone levels are found to be abnormal during an extreme illness or stressor. Euthyroid sick syndrome is also referred to as non-thyroidal illness or NTI because it's a result of underlying severe illness and not considered to be a result of primary thyroid disease.  This condition may be seen in people who are in the intensive care unit, during periods of starvation, or after major surgery.

While thyroid disorders are not uncommon, ESS presents a unique and intriguing challenge. It's a condition that can confound healthcare professionals, leading to misdiagnosis and misunderstanding.

How Does ESS Arise?

ESS is a fascinating yet complex phenomenon that arises primarily as a response to various underlying illnesses or life-threatening conditions.  When an individual faces severe illness, it's thought their body often initiates a series of adaptive changes as a means of conserving energy and resources. One of these adaptations involves alterations in thyroid hormone metabolism and production. 

In ESS, these changes can lead to decreased peripheral conversion of thyroxine (T4) to triiodothyronine (T3), which is the more biologically active form of thyroid hormone. It is theorized that these adaptations, driven by the body's innate survival mechanisms, aim to divert energy away from non-essential processes to prioritize vital functions during illness. 

While the exact mechanisms behind ESS are still a subject of ongoing research, it underscores the dramatic changes in the human body in response to severe conditions.

How to Determine Euthyroid Sick Syndrome

Determining ESS typically involves a multifaceted approach that combines clinical evaluation and laboratory testing. Healthcare providers begin by conducting a thorough medical history review and physical examination to identify any underlying illnesses or conditions that might be causing ESS.  

Thyroid Function Tests

 In ESS, thyroid function tests often reveal abnormal levels of thyroid hormones.  When thyroid levels are checked, they often show low T3 and sometimes also a low ft4 with a normal or slightly elevated TSH. However, the TSH is considered to be “inappropriately low” when considering the low levels of T3 and T4 hormones. Reverse T3 (rT3) may be measured to further support the diagnosis. 

Importantly, the interpretation of these tests should consider the clinical context, as ESS can often mimic the thyroid hormone pattern seen in genuine thyroid disorders. Therefore, a skilled healthcare provider's expertise in differentiating ESS from other thyroid conditions is invaluable in achieving an accurate diagnosis.

Hormone Levels

Serum triiodothyronine or T3 levels are the first to decrease, but with prolonged and severe illness, the T4 may also become low. If a reverse T3 or rT3 is obtained, it would be elevated and would represent deactivated thyroid hormone. The enzymes that deactivate (or activate) thyroid hormone are called deiodinases.

These levels result from a complex interplay of factors. They may stem from interference in the assay process caused by medications or compounds produced by the body. Additionally, enzymes like iodinases can alter hormone levels, and decreased hormone production originating from the hypothalamus and pituitary glands could also play a role in these fluctuations. (link to HP T diagram). 

The hormone alterations at the hypothalamus and pituitary may be secondary to cytokine production or medications such as dopamine and steroids. An additional factor that may play a role during illness/stress is an alteration in the binding of the T4 hormone by proteins.  

Some experts believe that the alteration in thyroid hormone may be a compensatory mechanism to reduce metabolism and conserve energy during illness/stress.  

Euthyroid Signs and Symptoms

It is often difficult to tease out the symptoms of hypothyroidism from signs and symptoms from the underlying stressor or illness. (link to symptoms of hypothyroidism listed previously). Adverse health outcomes are typically related to underlying illness or stress with thyroid abnormalities resulting secondary to primary illness.

Treating Euthyroid Sick Syndrome

Treating ESS primarily revolves around addressing the underlying cause or condition.  Since it usually arises as a response to critical illness, the first step is to manage the main health issue. It's important to tailor the treatment to each individual's specific situation and closely monitor their progress. 

Thyroid abnormalities in ESS are usually not treated because they often resolve as the underlying illness or sickness is treated. Although the decision to treat ESS is controversial in individuals who continue to have abnormal thyroid levels with an illness that is not improving, some studies that suggest treatment might be beneficial for select groups. 

In some cases, doctors may consider thyroid hormone replacement therapy, but this should be done cautiously because ESS typically resolves when the underlying issue is treated effectively.

Thyroid hormone levels should be monitored periodically during the illness and after its resolution to see if levels are improving as the illness resolves and return to normal after illness resolution.  

Get Expert Care from a Trusted Pediatric Endocrinologist

While ESS can occur in children and adults of all ages, we specialize in pediatric endocrinology, to assist those 26 and under. Your child's health is our top priority, and we're here to provide the support and answers you need to ensure they thrive. Don't hesitate to contact Dr. McIver, because every child deserves a healthy and bright future.

Whether you’re looking for a second opinion on a diagnosis or need expert care for your child, Dr. McIver is here for you.

The body goes through changes that are mediated by hormones at a young age. These changes can lead to a hormone imbalance in teens during puberty. When we talk about puberty, we are talking about how the pituitary starts making hormones that cause the ovaries in girls or testes in boys to produce estrogen and testosterone respectively.  

This is a complex process with the interplay of several hormones that we are still discovering.  See below for the hypothalamic pituitary gonadal axis of HPG axis for a description of what happens in the body during central puberty.

What is the timing of normal pubertal timing?

• Girls 8-13 years old (some girls may start puberty earlier)
• Boys 9-14 years old

What are the early signs of puberty as defined earlier?

• Girls - start with breast budding
• Boys - the doctor may check for testicular enlargement

You may notice body odor or body hair before these signs and these are likely caused by hormones produced by the adrenal glands and not the ovaries or testes. This is called peripheral puberty and not mediated by hormones from the brain.

Hypothalamus

Gonadotropin releasing hormone or GnRH

Pituitary

Luteinizing hormone or LH Follicle stimulating hormone or FSH

Gonad (ovaries or testes)

Girls-estrogen Boys-testosterone

Pubertal signs

First sign of central puberty: Girls-breast budding Boys-testicular enlargement

Some hormone imbalance in teens that may occur during puberty are:

Girls

• Irregular periods can be normal for the first couple of years
• Polycystic ovarian syndrome or PCOS: irregular periods and signs of excessive androgen production such as increase hair growth in particular areas of the body such as the above the lip or acne
• Early or precocious puberty:  Your child may be tall compared to her peers and develop early and faster than peers.  If your child is displaying signs of puberty before the age of 6 years of age then you should seek further medical evaluation

Boys

• Boys may encounter delayed puberty 
• Boys may encounter early or precocious puberty.  If displaying signs of early puberty, you should seek medical care right away for further evaluation

Hormonal Imbalance Treatment

If you are concerned about a pubertal disroder in your child, a pediatric endocrinologist is the specialist to seek. Dr. McIver is a board certified pediatric endocrinologist and is accepting new patients in Northern Colorado.

Do you ever wonder how often you should be getting your thyroid checked? Or even what is being checked by the doctor?  The labs that are obtained look at levels of the thyroid stimulating hormone (TSH) and free thyroxine or total thyroxine. 

The TSH is particularly important as it acts as a gauge. It tells us if enough thyroid hormone is being produced by the thyroid gland.  The TSH can be used reliably if there is no concern about brain function, specifically the hypothalamus and pituitary.  See the blog on hypothalamic pituitary thyroid axis if you want to learn more about how these hormones are regulated in the body. 

How often should you get thyroid checked? 

Most, if not all infants, get a newborn screen done before they leave the hospital in the US.  Part of this screening panel of tests, thyroid hormone level or levels are checked.  If you want to learn more about thyroid testing on the newborn screen click here.

After the newborn period, thyroid labs may be obtained depending on the clinical scenario.  They may be checked once if there is concern that you are displaying signs and symptoms of hypothyroidism. If they are normal there may be no need to check them again.  

If you have a thyroid condition, then labs are monitored regularly.  

• 0-6 months: labs may be checked every 1-2 months.  
• 6 mo - 2 years: labs are checked every 2-3 months.  
• 3 years and older: labs may be checked every 3-6 months. 

In children under the age of 3 years who have thyroid disease, labs are checked more frequently due to a couple of reasons.  

1. The child is growing rapidly and may need dose adjustments more frequently.  
2. This is a crucial time for brain development and levels are kept under tighter control to optimize neural development.  

What happens when the dose is adjusted? 

Another time when labs may be checked 4-8 weeks after the dose is changed. If there are signs and symptoms of hypothyroidism or hyperthyroidism while on replacement hormone therapy then levels would also need to be checked.  If you want to learn more about replacement therapy click here.

Hyperthyroidism is a condition where there is too much thyroid hormone in the body. This may occur due the autoimmune nature of the thyroid disease or if the dose prescribed is too much.  Click here if you are interested in learning about the hyperthyroid phase in Hashimoto’s. It's important to base the dose on lab results and not just symptoms, as symptoms do not provide reliable evidence for dose modifications.

The normal range of these tests depends on the age of the person and the assay used.  Labcorp’s reference ranges can be looked up easily at

• Thyroid Stimulating Hormone (TSH)
• Thyroxine, Free, Direct

Are you concerned that your child might have diabetes? Understanding pediatric diabetes is extremely important, especially since diabetes affects over 283,000 children and adolescents in the U.S.

The majority of children that suffer from this chronic disease have Type 1 diabetes. However, in recent years, Type 2 diabetes in children has increased dramatically.

Keep reading to get a better understanding about diabetes in children and how you can manage your child’s symptoms.

What is Diabetes?

Diabetes is a medical condition where blood sugar levels are too high either in a fasting state and or after eating.

If these levels continue to stay elevated, it can cause several serious health problems. In the long-run, heightened blood sugar levels will cause damage to many vital organs of the body. In the short-term, this condition can lead to hospitalization and, in severe cases, death.

Proactive medical management of diabetes is very important to keep the body healthy.

Can Children Inherit Diabetes?

Yes, children can inherit diabetes. There is a higher probability that your child will have diabetes if you have a family history of it. However, the disease is not always passed down genetically. Some types of diabetes develop in a child whose parents aren’t predisposed to the condition.

If you suspect your child has diabetes, then it’s important you learn about the different types of diabetes and their symptoms. Understanding pediatric diabetes is the key to proper management.

It’s also a good idea to seek expertise about diabetes in children from a pediatric medical professional rather than self-diagnosing.

3 Types of Diabetes

There are 3 types of diabetes that are seen most often in children. Each type of diabetes has a different cause.

• • Type 1 Diabetes: T1D is an autoimmune condition where the immune system gradually attacks the cells of the pancreas that make insulin. Insulin is a hormone that helps keep blood sugar levels in a narrow range.

• • Type 2 Diabetes: T2D is polygenic and typically there is a strong family history. The body makes insulin but the cells are resistant and it takes more insulin to keep blood sugar in the normal range. Over time, if blood sugars continue to be high, the body loses its ability to make insulin.

• • Monogenic Diabetes: This type of diabetes is caused by a single gene defect that typically impacts the release/production of insulin.

Oftentimes, young children suffer from Type 1 diabetes (T1D), which is believed to have an inherited component combined with certain environmental triggers. The cause of type 1 diabetes is not fully understood. However, some children may suffer from Type 2 diabetes (T2D) if they are overweight, inactive, or have a family history of the disease.

Symptoms of Diabetes in Children

Here are some common symptoms of diabetes in children. Take note that all types of diabetes have these symptoms.

• • Excessive thirst

• • Excessive urination

• • Urinary accidents in potty-trained children day or night

• • Weight loss

• • Excessive hunger

• • Fruity breath

• • Abnormal breathing

If you recognize these symptoms in your child, they may be suffering from diabetes. It’s important to diagnose the disease before starting a management regimen.

Understanding Pediatric Diabetes: Diagnosis

How do you diagnose diabetes in a child? First, it’s a good idea to call your child’s doctor. Your primary care doctor will request blood samples for further evaluation.

The following data indicates a person has diabetes:

• • Fasting blood glucose is over 125 mg/dL

• • Any random level over 199 mg/dL with matching diabetic symptoms

• • Hemoglobin a1c >6.4%

Once properly diagnosed, you will most likely be referred to a pediatric endocrinologist for proper health management.

Management of Diabetes in Children

Your child’s treatment regimen will depend on the main cause of the blood sugar elevation.

T1D Management

Individuals with Type 1 diabetes require insulin either delivered by injection or pumps.

Children with T1D will be evaluated for associated autoimmune conditions such as thyroid disorders and celiac disease. Talk to your pediatrician if you have a family history of these conditions.

T2D Management

Individuals with Type 2 diabetes who have a1c<8.5% can be managed with diet, exercise, and oral medications and those with severe blood sugar elevations typically require insulin.

T2D in children is different from adults in that it tends to be progressive if blood sugars levels are persistently elevated. Children with type 2 diabetes are evaluated for eye, kidney, and nerve complications soon after diagnosis.

Monogenic Diabetes Management

Depending on the genetic cause, individuals with Monogenic Diabetes may be treated with oral medications. Treatment may vary from patient to patient.

Additional Support for Children with Diabetes

Children with diabetes and their family members need ongoing one-on-one education, a tailored medical regimen, and social/emotional support.

There are many organizations and institutions that provide good resources for families with children with diabetes or young adults with diabetes. Some of these include:

• • Juvenile Diabetes Research Foundation

• • American Diabetes Association

• • Society of International Pediatric & Adolescent Diabetes

• • Children’s Diabetes Foundation

Diabetes is a challenging diagnosis and often requires a team of providers to properly manage.

Dr. McIver is a pediatric endocrinologist who specializes in chronic conditions in children.

Autoimmune diseases can affect people of all ages. The same is true for autoimmune thyroid diseases (AITDs) such as Hashimoto’s disease. In fact, many people are living with Hashimoto’s disease - even children!

It is estimated that between 1-2% of children live with the condition.  It can even manifest in toddlers.

At the end of the day, it’s important to understand this AITD and how it affects the lives of our kids. Keep reading to learn what Hashimoto’s disease is and how to treat it.

What is Hashimoto’s Disease?

First, let’s discuss what Hashimoto’s disease is. 

Hashimoto's disease is an autoimmune condition that affects the thyroid gland. It is also referred to as chronic lymphocytic thyroiditis. In this condition, the immune system may attack and destroy thyroid tissue. This leads to symptoms such as:

• Excessive fatigue
• Poor growth
• Weight gain
• Constipation
• Goiter 
• Muscle aches

It is unclear what causes Hashimoto’s disease. However, some experts suggest that genetics can play a role in the condition, along with environmental exposures.

Hashimoto’s Disease vs Hypothyroidism

Hypothyroidism is defined as having low thyroid hormone levels or underactive thyroid.  Oftentimes, hypothyroidism is a result of Hashimoto’s disease - as in it’s a common consequence.

However, it is important to note that Hashimoto's disease is not the same as hypothyroidism.  You can have Hashimoto’s disease but not have hypothyroidism. Alternatively, you can have hypothyroidism and not have Hashimoto’s disease. You can also have antibodies against the thyroid gland but not have inflammation of the gland. 

If you are unsure if your child is living with Hashimoto’s disease or hypothyroidism - or both - it’s best to seek medical advice from a pediatric endocrinologist. 

Phases of Hashimoto’s Disease

Living with Hashimoto’s disease can occur in 3 distinct phases. Not everyone will experience each phase, but it is important to recognize all 3 of them:

1. Dormant phase: you can have detection of antibodies against the thyroid gland and the thyroid gland continues to function the way it should
2. Destructive phase (Hashitoxicosis): an individual can experience transient hyperthyroidism when the thyroid cells release thyroid hormone in an unregulated manner. Hyperthyroidism happens when more thyroid hormones are released than needed. Not everyone will experience this.
3. Hypothyroid phase: Once enough tissue has been destroyed, hypothyroidism will occur. At this point, thyroid hormone replacement is needed.

As mentioned above, it’s important to know that not everyone’s body reacts the same to this disease. In fact, many medical professionals recognize the rule of thirds: 

• 1/3rd of those with positive antibodies will never need thyroid hormone replacement
• 1/3rd will develop hypothyroidism
• 1/3rd will experience hashitoxicosis

Now, let’s talk about how to diagnose the disease.

How to Diagnose and Evaluate Hashimoto’s Disease

If you suspect your child is suffering from this AITD, a pediatric endocrinologist can evaluate the condition through blood work.

Most likely, blood work will detect positive antibodies for the disease. However, this is not always the case.  

Depending on the rule of thirds, abnormal thyroid hormone values may be detected. If an ultrasound is obtained, the thyroid gland may be enlarged, which will show increased blood flow and appear to have pseudonodules giving the gland a giraffe-like pattern.  

Overtime, if the gland gets destroyed, it will appear atrophic, or small with decreased blood flow.  Take note that an ultrasound is not required to make the diagnosis nor needed for routine management.

Is There a Dietary Treatment for Hashimoto’s Disease?

Are there placebo controlled dietary intervention studies in people who have hashimoto’s disease?  Unfortunately no, these studies do not exist. The answer is not straight-forward. 

However, there is much more evidence that an inflammatory diet increases the risk for cardiac disease, cancer, Alzheimer's disease, and other diseases. So, if the symptoms do not improve with thyroid medication, you may want to consider diet and food choices. 

First, you can incorporate more fresh fruits and vegetables in your child’s diet. Next, reduce or eliminate processed foods such as refined carbohydrates and processed meats like bacon and hotdogs. 

Keep in mind that taking on a very restrictive diet may put your child at risk for nutritional deficiencies. It’s always a good idea to talk to your pediatrician before you radically change your child’s diet.

How to Treat Hashimoto’s disease

Once the diagnosis is made by your pediatric endocrinologist, the hypothyroidism can be treated with thyroid hormone replacement. Symptoms will typically improve with treatment. 

If they do not, there may be other options for treatment or a further evaluation for other associated conditions may be required. Additionally, your child will need lifelong monitoring of their  thyroid levels to stay healthy.

Concerned Your Child is Living with Hashimoto’s Disease?

Although not uncommon, living with Hashimoto’s disease is a reality for some children. 

If you are concerned about your child’s health or have questions about this disease and its effects on children, a pediatric endocrinologist, like Dr. McIver, can help.

 

Are you wondering, “what is the HPT axis?” Perhaps you heard the term mentioned by your doctor or you read it in a health forum. But, what exactly is it and how does it play a role in your overall well being? 

In this article, find out everything you need to know about the HPT axis, your thyroid, and the hormones that it regulates. Let’s dive right in!

What is the Hypothalamic-Pituitary-Thyroidal (HPT) Axis?

In essence, the HPT axis is an acronym for the hypothalamic-pituitary-thyroid axis. It relates to your hypothalamus and pituitary gland. This means that it plays an integral part in your thyroid hormones!

HPT Axis and Your Hormone Levels

Your thyroid is located in the front of your neck and just below your “Adam’s apple.” Its job is to take iodine (found in the food you swallow) and form special thyroid hormones that help regulate your metabolism, growth and development.

Thyroid hormone levels are tightly regulated in the body. As depicted in the diagram below, there is a feedback loop that keeps hormones at appropriate levels.

In other words, it’s a checks and balance arrangement between the various hormones and glands.

So, what does the hypothalamus and pituitary gland do and how do they relate to the HPT axis?

What is the Hypothalamus?

First, the hypothalamus is part of the brain that helps control the hormone production of the pituitary gland. That means the hypothalamus and the pituitary gland go hand in hand! 

In fact, it is physically connected to the pituitary gland with the pituitary stalk or infundibulum. The hypothalamus sends chemical messages to the pituitary gland and regulates many other hormones such as:

• Cortisol
• Growth hormone
• Sex steroids
• Antidiuretic hormone

Without the help of the hypothalamus, your body’s hormones - in particular, your sex and growth hormones - would not be regulated properly.

What is the Pituitary Gland, aka the “Master Gland?”

Next, the pituitary gland, better known as your body’s master gland, is located at the base of the brain and behind the nose. The pituitary gland is made up of 2 distinct lobes. 

The lobe closer to the front is called the anterior pituitary gland or adenohypophysis. Meanwhile, the lobe closer to the back of the head is called the posterior pituitary gland or the neurohypophysis. 

For starters, the anterior pituitary secretes hormones such as:

• Thyroid stimulating hormone
• Adrenocorticotropin
• Luteinizing hormone 

Respectively, these chemical messages tell the thyroid gland, adrenal gland, and the gonads to release thyroxine, cortisol, and estrogen/testosterone.

Now that you know which hormones are produced in the hypothalamus and stored in the posterior pituitary gland, you’re probably wondering how the HPT axis actually works. 

Let’s take a look!

How Does the HPT Axis Work?

In simple terms, the hypothalamus and pituitary release just the right amount of hormones or chemical messages that stimulate the thyroid gland to release thyroxine (T4) and triiodothyronine (T3). Then the thyroid gland releases mostly thyroxine, which gets converted into the active form of thyroid hormone. It’s worth noting that there are thyroid hormone receptors (or sensors) on the hypothalamus and pituitary gland that then downregulate the thyroid from releasing too much hormone.

Importance of a Functioning HPT Axis

Can Children Experience Thyroid Hormone Imbalances?

Contrary to popular belief, thyroid hormone imbalances can happen to people of all age ranges - including children. 

An issue in the hypothalamus, pituitary, or thyroid gland can cause an imbalance in the system, even to patients under the age of 12. This could lead to stunted growth, hypothyroidism, and a slow metabolic rate. 

What to Do About Hormone Imbalances in Children

Here’s the good news: Modern medicine allows medical professionals to evaluate the hormones in these glands. Based on these results, your pediatric endocrinologist can figure out where the imbalance is and offer treatment to get you back in balance.