Expert evaluation and treatment for thyroid disease
The Thyroid Disease Clinic in the Division of Pediatric Endocrinology at Floating Hospital for Children is centered on providing infants, children and adolescents focused evaluation and exceptional treatment for the range of thyroid diseases.
A healthy thyroid makes the hormone that controls metabolism and growth. When the gland is overactive and releases too much thyroid hormone, it results in hyperthyroidism. When the thyroid is underactive, it produces too little of the hormone and results in hypothyroidism. In both of these conditions, a goiter can form when the thyroid becomes larger than normal and is easily seen on the front of the neck.
Whatever your child’s diagnosis, you can feel rest assured that the expert Pediatric Endocrinology team at Floating Hospital will be there every step of the way to make sure that your child gets the most effective treatment possible.
The doctors at Floating Hospital for Children have led the way in detecting and treating thyroid disease in infants. Marvin Mitchell, MD, who at one time worked at Floating Hospital, was the first doctor to develop screening guidelines for congenital hypothyroidism. In 1976, Dr. Mitchell and a team of Pediatric Endocrinologists, including our Chief of Pediatric Endocrinology, Abdollah Sadeghi-Nejad, MD, began screening children across New England for this disease. In fact, the first baby found with congenital hypothyroidism through this screening process was born at Floating Hospital.
The congenital hypothyroidism screening process is still used today to find and treat kids early, before any negative side effects can develop. Although children with hypothyroidism have to take the medication throughout their lives, the treatment is simple and leads to very good results. Once your child starts the medication, we schedule regular check-ups so that we can monitor his/her hormone levels as she/he grows.
Neonatal hyperthyroidism is a genetic disease in which mothers who have hypothyroidism or have been treated for it pass thyroid stimulating hemoglobins to the baby. Specialists in the Division of Maternal-Fetal Medicine at Floating Hospital typically find signs of this disease during prenatal screenings by discovering a rapid pulse or failure to thrive.
Once we receive word that a baby has been born with hyperthyroidism, we begin treatment right away. These infants typically need medical treatment for 3-4 months but can then stop taking the medications and go on to live a healthy and normal life.
Children who develop hypothyroidism are usually on the small side, have low energy, are cold all the time, need lots of sleep, are constipated and have dry hair and dry skin. As Dr. Sadeghi-Nejad describes it, these children just “don’t have that sparkle” that other kids often have.
Hypothyroidism is most commonly caused by Hashimoto’s Thyroiditis, which causes your child’s immune system to attack the thyroid gland, preventing it from producing enough hormones. When a child is suspected to have hypothyroidism we use blood testing to evaluate their thyroid hormone levels. Even if your child has a low thyroid hormone level, we may recommend waiting to see if the symptoms get better because 30-40% of kids with hypothyroidism have a spontaneous recovery.
If your child his diagnosed with hypothyroidism, he or she will have to take a small pill every day. We understand that lifelong medication is something that many people want to avoid, so we take every step possible to make sure that taking this medication is essential for your child’s health. The good news is that if your child does take the medication, the treatment is very simple and doesn’t have many side effects.
Children with hyperthyroidism are jittery, can’t sit still, chatty, very hyperactive, hot all of the time and inappropriately moody. Graves disease is the most common cause of hyperthyroidism. It makes a child’s immune system produce abnormal antibodies that mimic thy thyroid stimulating hormone, causing the gland to become overactive.
The doctors in the Division of Pediatric Endocrinology typically diagnose Graves disease and hyperthyroidism using a physical examination and blood tests. Once a diagnosis is made, we begin to explore the 3 main treatment types, although we typically start with medications and progress from there.
- Medicine – The advantage of treating hyperthyroidism with medications is that the anti-thyroid medication has very little side effects so your child can take it for 2-3 years and if it does not seem to be reducing the symptoms, we can move on to other treatment options. The disadvantage is that if the medications do not work in that time frame, your child may need a more permanent solution.
- Surgery – The General and Otolaryngology Surgeons at Floating Hospital can perform a surgery to remove part of the gland so that it makes less of the thyroid hormone. The advantage of surgery is that it is quick and you can get treatment over with. The negatives include the risk of surgery, scarring and the fact that the surgeon often will not know the exact amount that needs to come out. The result is that the thyroid may become underactive if the surgeon takes too much or remain overactive if the surgeon takes too little.
- Radioactive iodine – The advantage of this radioactive medicine is that it is cheap and there are often no immediate side effects. The disadvantage is that it is difficult to prescribe the right amount of radioactive iodine that should be taken, which can result in an underactive thyroid if your child takes too much. Also, parents often worry if this treatment can lead to an increased risk of cancer or damage to fertility/offspring.
Thyroid nodules are more common in adults but can be found in kids. These masses are small lumps in the thyroid gland that are typically benign but can be a sign of cancer, including papillary carcinoma, MEN-I or MEN-III.
If your pediatrician thinks that your child may have a nodule, they might recommend seeing a Pediatric Endocrinologist. At Floating Hospital, we use ultrasound and radioactive scanning to learn more about your child’s nodule and assess the risk of malignancy. When we find these nodules, we often monitor the nodule before taking corrective action because taking out part or all of the thyroid can mean that your child will have to be on lifelong medication. The general and otolaryngology surgeons at Floating Hospital are typically successful using this procedure. If a thyroid tumor is found, we will work closely with our colleagues in Pediatric Hematology/Oncology to provide your child comprehensive treatment.
To make an appointment, please call 617-636-8100.