How is pediatric hypothyroidism treated?
We treat hypothyroidism by replacing your child’s missing thyroid hormones. To do this, we prescribe a small pill appropriate for all ages. The pill is a synthetic thyroid hormone called levothyroxine. It is chemically the same as T4, and it brings your child’s thyroid hormones up to a healthy level. Rarely, patients also need to take the synthetic hormone called liothyronine to replace the thyroid hormone T3. This depends on your child’s response to treatment.
The pills must be taken every day, and they are best absorbed on an empty stomach. You can crush the pills into a tablespoon of food or liquid such as applesauce, water, breast milk or formula, as long as you do this every time. Don’t mix it into a full bottle of liquid.
Try to give your child their medicine at the same time each day. Any time of day is ok, though we recommend the morning. Some foods and supplements can block the medicine from working, and shouldn’t be taken at the same time, though they can be used at another time of the day. These include soy products (including soy-based formula), high-calcium foods and iron supplements. Tell us about any other supplements or medicines your child is taking. Some medicines may affect dosing, such as birth control pills and supplemental estrogen or testosterone.
If your child misses a dose, you can give it to them later in the day, or you can give them two doses the next day.
We recommend that families avoid changing medicine brands. Switching pill brands can cause your child’s hormone levels to go up and down. We also recommend that families avoid liquid preparations of the medicine, which can settle and provide uneven dosing. If your child cannot swallow pills, they can chew them, or take them crushed in their food.
After 4 to 6 weeks on this medicine, we will give your child another blood test to make sure their thyroid hormones are at the right levels. If needed, we will adjust their medicine dose. Never change your child’s medicine dose on your own. Taking too much thyroid hormone can cause heart and bone problems.
How is hypothyroidism monitored in children?
Thyroid medication needs to be monitored frequently with blood tests. Children under 3 years old, who are growing quickly, need their thyroid levels checked every 3 months. This will be even more frequent for children under 6 months of age. Parents can also watch for symptoms that their baby or toddler’s medicine dose needs to change and tell their doctor. If your child is getting too much medicine, you may see irritability, trouble sleeping, weight loss, increased hunger and frequent bowel movements (pooping). If your child is getting too little medicine, you may see excessive sleeping, constipation, weight gain, low energy and cold, dry skin. It is normal for your child to be more awake and active after beginning thyroid medicine.
After the age of 3, children need their thyroid levels checked every 6 months, or when they have any changes in symptoms. Repeat testing is also needed 1 to 2 months after your child’s dose is changed for any reason.
We will need to adjust your child’s medicine as they grow. If their dose is too low, it won’t resolve their hypothyroidism. If their dose is too high, it will cause hyperthyroidism. Hyperthyroidism is when thyroid hormone levels are too high. We will also monitor your child’s growth and development.
Some children may outgrow the need for thyroid hormone replacement. However, most will need treatment throughout their life. Even after your child’s brain has finished developing, people need thyroid hormones for normal growth and energy, and normal adolescent and adult development.
In some cases, your pediatrician may be comfortable managing your child’s thyroid condition. Otherwise, your child will need to see a pediatric endocrinologist for their follow-up care.
Why Choose Children’s Hospital Colorado for your child’s pediatric hypothyroidism treatment?
We treat your child as an individual and work with your family to determine the best approach for their care. Together, we consider your child’s diagnosis, overall health and preferences to develop a treatment plan. Our multidisciplinary care team includes a nutritionist, a diabetes educator, a clinical social worker and a psychologist to assist with any related health challenges.
Our Department of Pediatric Endocrinology provides a full range of medical, radiologic and surgical therapies. We have nursing and medical support available 24 hours a day, 7 days a week, for Children’s Colorado patients and their families.