Although thyroid disorders in children are relatively rare, conditions affecting the thyroid gland may be congenital (present at birth) or develop during early childhood. Abnormal thyroid function can be linked to genetic, environmental, or autoimmune factors. In Türkiye, the prevalence of pediatric thyroid disorders is lower compared to the general population; however, factors such as iodine deficiency may increase the risk.

Common Thyroid Disorders in Children

• Hypothyroidism: A condition in which the thyroid gland does not produce enough hormones. It may be congenital or acquired. Treatment requires lifelong thyroid hormone replacement therapy.

• Hyperthyroidism: A condition in which the thyroid gland produces excessive hormones. The most common cause is Graves’ disease. If medication fails to control the condition, thyroidectomy (surgical removal of the thyroid) may be necessary.

• Thyroid Nodules: Lumps or masses in the thyroid gland. While usually benign in children, there is a risk of malignant transformation. Nodules with suspicious features or confirmed malignancy should be treated with surgical removal of the thyroid gland.

• Congenital Thyroid Disorders: These are present from birth and are usually detected through newborn screening programs. They often present as congenital hypothyroidism.

Both nodular disease and congenital thyroid conditions may lead to either hypothyroidism or hyperthyroidism depending on the nature of the disorder.

Symptoms

• Hypothyroidism may present with:

  • Fatigue

  • Weight gain

  • Cold intolerance

  • Constipation

  • Dry skin

  • Hair loss

  • Poor growth and development

  • Low energy levels

• Hyperthyroidism may present with:

  • Irritability

  • Weight loss

  • Excessive sweating

  • Rapid heartbeat

  • Hand tremors

  • Heat intolerance

  • Sleep disturbances

• Thyroid Nodules often do not cause symptoms. However, large nodules may lead to:

  • Visible swelling in the neck

  • Difficulty swallowing

  • Shortness of breath

On physical examination, a neck mass or tenderness over the thyroid gland may be detected. Neck ultrasonography is used for detailed imaging. If necessary, fine-needle aspiration (FNA) biopsy is performed under ultrasound guidance to evaluate the nature of the nodule. The decision to proceed with thyroidectomy depends on biopsy results.

Surgical Treatment

If thyroid removal is indicated, surgery is planned and performed through a 3–4 cm incision in the lower neck. The thyroid gland is located near critical anatomical structures, so complications such as bleeding, infection, vocal cord injury (hoarseness), or thyroid hormone imbalances may occur, although these are rare in experienced centers.

• If the entire thyroid gland is removed, the child must begin lifelong thyroid hormone replacement therapy.

• If only a portion of the thyroid or a single nodule is removed, medication may not be necessary.

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