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Congenital Hypothyroidism

What Is the Thyroid?

The thyroid is a small gland located below the skin and muscles at the front of the neck, just at the spot where a bow tie would rest.

It's brownish red, with left and right halves (called lobes) that look like a butterfly's wings. It weighs less than an ounce, but helps the body do many important things, such as grow, regulate energy, and go through sexual development.

What Is Congenital Hypothyroidism?

Hypothyroidism (or underactive thyroid) is when the thyroid gland doesn't make enough of some important hormones. When children are born with it, it's called congenital hypothyroidism.

In other cases, kids and teens develop hypothyroidism later, usually late in childhood or as teens due to the autoimmune disease Hashimoto's thyroiditis.

What Are the Signs & Symptoms of Congenital Hypothyroidism?

Early signs of congenital hypothyroidism in a baby include:

  • jaundice (yellow skin or eyes)
  • sleeping longer or more often than usual
  • constipation
  • a large soft spot (fontanel) on the head
  • large, swollen tongue
  • weak ("floppy") muscle tone
  • swelling around the eyes
  • poor or slow growth
  • cool, pale skin
  • large belly with the navel sticking out

Without treatment, children with congenital hypothyroidism can develop permanent mental disabilities. They also may have a poor appetite and breathing problems.

What Causes Congenital Hypothyroidism?

Most cases of congenital hypothyroidism happen because the thyroid doesn't form correctly in the baby during pregnancy. At birth, the baby may have no thyroid gland at all, or have a small, partially developed gland. Why this happens is often unknown, but in some cases it is genetic.

Less commonly, a baby's thyroid did fully develop, but it can't make normal amounts of thyroid hormone. This is usually due to a genetic problem. Other children born to the same parents have a 1 in 4 chance of having the same thyroid problem. 

How Is Congenital Hypothyroidism Diagnosed?

It's very important to diagnose and treat hypothyroidism promptly. So thyroid testing is done on all infants at birth as part of normal newborn screening.

A heel prick blood sample is tested to look for:

  • low levels of T4 (thyroxine), a hormone made by the thyroid that helps control metabolism and growth
  • high levels of TSH (thyroid stimulating hormone), made by the pituitary gland to stimulate the thyroid and increase its production of thyroid hormones

If the newborn screen test is abnormal, other blood test are done to be sure of the diagnosis. Sometimes doctors order imaging tests, such as an ultrasound or a thyroid scan, to get more information.

How Is Congenital Hypothyroidism Treated?

A child with hypothyroidism will take thyroid hormone to make up for what the thyroid gland can't make. Most kids need to take the medicine for the rest of their lives.

Some infants are born with temporary hypothyroidism. This can be caused by things such as premature birth, thyroid disease in the mother, or medicines the mother had during pregnancy. This form of hypothyroidism usually goes away by itself in the first weeks or months of life.

How Can I Help My Child?

If your child has hypothyroidism, it's very important to give the thyroid hormone as instructed by your doctor.

If your child is too young to chew or swallow the pill, crush it and mix it with a small amount of water, non-soy baby formula, or breast milk. Make sure your child drinks all the liquid. Some thyroid hormone pills dissolve more easily in liquids than others, so talk to your doctor if you're having trouble with this.

Some infant formulas (especially soy formulas), medicines, and mineral supplements (like calcium and iron) may block the thyroid medicine from being absorbed correctly. Check with your doctor about how and when to give other medicines or supplements while your child takes thyroid hormone.

What Else Should I Know?

Your doctor will need to see your child regularly to make sure that the medicine is working and adjust the dose as your child grows. Be sure to go to all follow-up appointments.

Children with congenital hypothyroidism can sometimes develop hearing problems. If you have any concerns about your child's hearing or speech development, talk to your doctor.

Date reviewed: April 2018