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18 PEDIATRIC THYROID DISEASES : A COMPREHENSIVE REVIEW
Abhishek Sharma
Bugubaeva Makhabat Mitalipovna
(1. Medical Student, International Medical Faculty, Osh State University, Osh, Kyrgyzstan
2. Teacher, Department of clinical discipline 2 (Pediatrics), International Medical Faculty, Osh state University, Osh, Kyrgyzstan)
ABSTRACT
Thyroid disease is one of the most common pathologies in the world, with two of the most clinically important subgroups being iodine deficiency and thyroid goiter, and thyroid cancer. This review looks at the current state of thyroid disease in the world and evaluates the future direction in terms of thyroid disease treatment and prevention. Several of the most impactful epidemiologic studies are presented and analyzed, as well as a brief overview of the current socioeconomic burden of disease.
Keywords: Thyroid gland, Hypothyroidism, Hyperthyroidism, Goiter, Thyroiditis, Graves’ disease, Hashimoto thyroiditis, Thyroid cancer, Iodine deficiency.
I. INTRODUCTION
Thyroid disease is a medical condition that affects the structure and/or function of the thyroid gland. The thyroid gland is located at the front of the neck and produces thyroid hormones that travel through the blood to help regulate many other organs, meaning that it is an endocrine organ.
Thyrotropin-releasing hormone (TRH), a tripeptide synthesized in the hypothalamus, stimulates the release of pituitary thyroid stimulating hormone (TSH). These hormones normally act in the body to regulate energy use, infant development, and childhood development.
Thyroid diseases are disorders involving the thyroid gland, leading to abnormalities in hormone production such as hypo- or hyperfunction , gland size (goiter), inflammation (thyroiditis), or tumor formation (benign or malignant).
Classification:
1. Functional classification
Hypothyroidism – Decreased thyroid hormone secretion
hyperthyroidism (Thyrotoxicosis) – Increased thyroid hormone secretion
2. Morphological classification
Diffuse enlargement
Nodular enlargement
Inflammatory
Neoplastic
Hypothyroidism
Hypothyroidism is an endocrine disease in which the thyroid gland does not produce enough thyroid hormones. As a result metabolism slows down. This can cause unintentional weight gain and make you feel exhausted all the time.Hypothyroidism can affect anyone. It’s most common among females over age 60, particularly after menopause.
• Congenital Hypothyroidism
Congenital hypothyroidism occurs in approximately 1 in 2,000-4,000 live births and is caused by dysgenesis (agenesis, aplasia, ectopia) or, less often, dyshormonogenesis (e.g., enzyme defects). Thyroid tissue usually is not palpable in these sporadic nongoitrous conditions. Dyshormonogenesis, disorders of intrathyroid metabolism, or goitrous congenital hypothyroidism occurs in about 1 in 30,000 live births.
• Acquired Hypothyroidism
Acquired hypothyroidism is an underactive thyroid that develops after birth, most commonly caused by an autoimmune condition called Hashimoto's thyroiditis. It can also result from iodine deficiency, radiation therapy, certain medications, or damage to the thyroid gland, leading to a range of symptoms such as fatigue, weight gain, and a feeling of being cold.
• Hashimoto Thyroiditis
Also known as autoimmune or chronic lymphocytic thyroiditis in which the thyroid gland is gradually destroyed. Hashimoto thyroiditis is a common cause of goiter and acquired thyroid disease in older children and adolescents.
Hyperthyroidism
Hyperthyroidism is a endocrine disease in which the thyroid gland produces excessive amounts of thyroid hormones. Thyrotoxicosis is a condition that occurs due to elevated levels of thyroid hormones of any cause and therefore includes hyperthyroidism.
• Graves disease
Most children with hyperthyroidism have Graves disease, the autonomous functioning of the thyroid caused by autoantibodies (thyroid-stimulating immunoglobulins [TSIs]) stimulating the thyroid. The resulting excessive synthesis, release, and peripheral metabolism of thyroid hormones produce the clinical features. Hashimoto thyroiditis and thyrotoxicosis are on a continuum of autoimmune diseases; there is overlap in their immunological findings.
• Congenital Hyperthyroidism
Congenital hyperthyroidism is a rare condition where an infant is born with an overactive thyroid gland, resulting in excessive thyroid hormone production. It is often caused by maternal Graves' disease, where antibodies from the mother cross the placenta and stimulate the fetus's thyroid.
Etiology
1. Congenital Hypothyroidism :- Caused by thyroid dysgenesis (agenesis, hypoplasia, ectopia), dyshormonogenesis (enzyme defects in hormone synthesis), maternal iodine deficiency or excess, maternal antithyroid drugs, or transplacental TSH receptor-blocking antibodies.
2. Acquired Hypothyroidism :- Result from autoimmune destruction (Hashimoto thyroiditis), iodine deficiency or excess, thyroid surgery or radioiodine therapy, drugs (lithium, amiodarone), pituitary or hypothalamic disease (secondary hypothyroidism), and post-inflammatory or infectious damage.
3. Hashimoto Thyroiditis :- Caused by genetic predisposition (HLA-DR3, DR5), environmental triggers, and formation of autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG), leading to gradual thyroid gland destruction and hypothyroidism.
4. Graves Diseases :- Predisposing factors include - Genetic susceptibility (HLA-DR3, HLA-B8),Family history of autoimmune thyroid disease, Emotional or physical stress, Infections, Smoking (exacerbates ophthalmopathy), Female gender and middle age.
5. Congenital Hyperthyroidism :- Occurs due to transplacental passage of maternal thyroid-stimulating antibodies (TSI) from mothers with active or treated Graves’ disease. Other rare causes include: Activating mutations in the TSH receptor gene (familial non-autoimmune hyperthyroidism), Neonatal iodine excess or maternal antithyroid drug withdrawal before delivery (transient hyperthyroidism).
Risk Factors
1. Hypothyroidism
Older age (>50 years) and female gender
Immune system disorders, including Hashimoto's thyroiditis
Thyroid or autoimmune disease in the family
Iodine excess or deficiency
Using radioactive iodine treatment or thyroid surgery
Medicines: Interferon-α, lithium, and amiodarone
Disease of the pituitary or hypothalamus (secondary causes).
2. Hyperthyroidism
Female gender (most prevalent in the 20–50 age range)
Graves' illness is an autoimmune disorder.
History of hyperthyroidism in the family
Excessive use of iodine or medications containing iodine (such as amiodarone)
Toxic adenoma or toxic multinodular goiter
Subacute or postpartum thyroiditis
Stress and smoking, particularly in Graves' illness.
Complications
1. Hypothyroidism Complications
Myxedema coma: extreme hypothyroidism that can be fatal
Chronic TSH stimulation causes goiter.
Unusual menstruation and infertility
Atherosclerosis and hyperlipidemia
Pericardial effusion and bradycardia
Children's mental delay and growth retardation (cretinism)
Cognitive decline and depression.
2. Hyperthyroidism Complications
Thyrotoxic crisis, or thyroid storm, is a severe, sometimes fatal condition.
Both cardiac failure and atrial fibrillation
Increased bone resorption, or osteoporosis
Muscle atrophy and weight loss
Eye issues: ophthalmopathy (in Graves' illness) and exophthalmos
Compression of the esophagus or trachea is a consequence of goiter.
Infertility and irregular periods.
3. Thyroid Nodule/Goiter Complications
Compression symptoms include trouble swallowing or breathing.
Internal bleeding or infection in the nodule
Rarely, malignant transformation.
Nodules/ Tumors of the Thyroid
Thyroid gland tumors are abnormal growths or proliferations of thyroid tissue that originate from the thyroid's follicular or parafollicular cells. They can be benign (non-cancerous) or malignant (cancerous). Depending on their form and origin, they might influence hormone secretion, local structures, or spread to distant organs. They can manifest as a single thyroid nodule or as a distributed gland enlargement.
• Clinical Features
Thyroid nodule or swelling without pain
May result in pressure symptoms including hoarseness and dysphagia.
Lymphadenopathy of the cervical region, particularly papillary cancer
In more severe situations, metastatic symptoms (cough, bone pain).
I. RESEARCH METHODOLOGY
In the survey we conducted personally among the people of India. Kerala has the highest rate of thyroid diseases in India, according to the National Family Health Survey (NFHS-IV, 2015–2016) and other public health data. Kerala has the highest prevalence of goitre or thyroid-related disorders in the nation, with over 8,700 women aged 15 to 49 per 100,000.
• Reason why Kerala has highest rate of thyroid diseases:
i. Kerala consumes a lot of seafood and iodized salt, which results in an excessive intake of iodine. This can throw off the thyroid hormone balance and cause conditions like Graves' disease and Hashimoto's thyroiditis.
ii. Compared to other states, Kerala has more thyroid illness diagnoses and reports because its citizens receive routine health examinations.
iii. Research indicates that some Kerala families have a higher prevalence of autoimmune thyroid conditions, suggesting a genetic component to the state's population.
iv. Obesity, high levels of stress, and sedentary lifestyles are prevalent in Kerala and are recognized risk factors for hypothyroidism.
v. Thyroid function may be hampered by fluoride levels in water and some goitrogenic diets (such as cruciferous vegetables and cassava). Thyroid dysfunction may also be influenced by environmental pollutants.
With between 5,000 and 7,000 cases per 100,000 women in the same age range, Telangana, Delhi (NCT), and Jammu & Kashmir have the highest thyroid disease rates after Kerala.
Thyroid diseases are more common in southern and northern hilly parts of India, such as Kerala, Tamil Nadu, and Jammu & Kashmir, than in many central or northeastern states. Higher health awareness and testing rates, as well as residual iodine deficiency in some areas, are believed to be some of the contributing elements to this pattern.
II. RESULTS AND DISCUSSION
In this graph we found that Saudi Arabia has highest percentage of thyroid diseases which is 73%
And lowest percentage country is South Korea which is 1% About 1 in 4,000 to 5,000 live births occur in the United States. Approximately 1 in 3,000 live births occur in Europe. About 1 in 5,700 live births occur in Japan.
• Iran: Research indicates a higher prevalence of 1 in 1,000 live births. Greece has a significantly higher rate of 1 in 800 live births.
Treatment
• For Graves Disease:
1. Radioiodine - Radioiodine (131I) is slower in exerting therapeutic effects, may require repeated dosing, and is likely to cause permanent hypothyroidism. Hypothyroidism is the desired outcome because it is easier and safer to treat than continued hyperthyroidism. This method of treatment is entering the mainstream for children and adolescents. Radioiodine given to a pregnant teenager renders the fetus hypothyroid and is contraindicated.
2. Surgery - Surgical treatment consists of partial or complete thyroidectomy.
• For Thyroid Nodules:
Treatment includes total thyroidectomy, selective regional node dissection, and radioablation with 131I for residual or recurrent disease. The prognosis is usually good if the disease is diagnosed early.
Prevention
1. Iodine supplementation: To prevent iodine-deficiency illnesses (goiter, hypothyroidism, and congenital hypothyroidism), all salts should be iodized.
2. Early screening: Regular thyroid function testing in high-risk categories (pregnant women, the elderly, and patients with autoimmune diseases) and newborn screening for congenital hypothyroidism.
3. Steer clear of too much iodine: Avoid iodine-induced thyroiditis or hyperthyroidism.
4. Reduce neck radiation exposure: To lower the risk of thyroid cancer, especially in children and young people.
5. Healthy lifestyle: avoiding goitrogens in high-risk groups, maintaining a balanced diet, and getting enough selenium.
6. Education and awareness: Timely diagnosis and treatment depend on early symptom detection (e.g., goiter, weight fluctuations, weariness).
Conclusion
The great frequency and systemic effect of thyroid problems make them a major worldwide health concern. Numerous organ systems and metabolism are impacted by the prevalent and varied thyroid disorders. Effective care and the avoidance of major problems are ensured by early detection by clinical and laboratory examination. The burden of illness is greatly decreased by public health initiatives like iodine fortification and awareness campaigns.
To reduce morbidity, prompt identification, suitable diagnostic assessment, and evidence-based treatment are crucial. Reducing the worldwide prevalence of thyroid disorders still largely depends on preventive measures like early screening and iodine supplementation.
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