NCLEX Review Guide: Pediatric Thyroid Disorders

Congenital Hypothyroidism

• Congenital hypothyroidism is the most common preventable cause of intellectual disability, requiring immediate treatment within the first 2 weeks of life. Newborn screening is mandatory in all states to detect this condition early.
• Clinical manifestations include prolonged jaundice, feeding difficulties, constipation, lethargy, and macroglossia. Growth retardation and developmental delays become apparent if untreated.
• Treatment involves lifelong levothyroxine (Synthroid) replacement therapy, with dosing based on weight and regular monitoring of TSH levels.

Acquired Hypothyroidism

• Hashimoto's thyroiditis is the most common cause of acquired hypothyroidism in children, presenting with gradual onset of symptoms. The condition is more prevalent in adolescent girls and has an autoimmune etiology.
• Symptoms include weight gain, cold intolerance, fatigue, dry skin, hair loss, and declining school performance. Growth velocity may decrease significantly in affected children.

Graves' Disease

• Graves' disease accounts for 95% of hyperthyroidism cases in children, with peak incidence during adolescence. The condition is caused by thyroid-stimulating immunoglobulins that mimic TSH action.
• Clinical manifestations include tachycardia, hypertension, weight loss despite increased appetite, heat intolerance, and behavioral changes. Exophthalmos may be present but is less common in children than adults.
• Treatment options include antithyroid medications (methimazole preferred), radioactive iodine, or surgical thyroidectomy. Beta-blockers may be used for symptom management during initial treatment.

Assessment Priorities

1. Monitor vital signs, especially heart rate and blood pressure for cardiac complications
2. Assess growth parameters (height, weight, head circumference in infants) at each visit
3. Evaluate developmental milestones and school performance regularly
4. Monitor for medication side effects and compliance issues

Patient/Family Education

• Emphasize the importance of medication compliance and taking thyroid medications on an empty stomach, 30-60 minutes before breakfast. Consistent timing improves absorption and maintains stable hormone levels.
• Teach families to recognize signs of medication over-dosage (hyperthyroid symptoms) or under-dosage (hypothyroid symptoms). Regular follow-up appointments and lab monitoring are essential.
• Discuss the chronic nature of thyroid disorders and the need for lifelong management in most cases. Provide emotional support for adolescents adjusting to chronic illness diagnosis.