Thyroid gland diseases in childhood and adolescence

Clinically significant hypothyroidism and hyperthyroidism are rare in childhood (congenital hypothyroidism 1 in 3000, hypothyroidism in Hashimoto's thyroiditis 1 in 2000 and hyperthyroidism in Graves' disease 1 in 100,000). Early diagnosis and treatment ensures that most affected children will have a normal mental and somatic development. Because clinical symptoms are nonspecific, a large number of laboratory diagnostic procedures are currently performed in order to exclude hypothyroidism and hyperthyroidism in childhood; therefore, the differentiation between a functional disorder requiring treatment and normal individual variants of thyroid stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) is nowadays just as important as the execution and control of evidence-based therapy itself. Thyroid nodules represent the second main aspect of thyroid disease in childhood. In Germany a large number of incidental ultrasound findings lead to the challenge of the differential diagnosis between the few malignant nodules that need to be treated by an operation and radioiodine therapy among the large number of benign nodules in a fine needle biopsy.