Thyroid Disorders in Children

Underactive Thyroid, Overactive Thyroid, and Other Thyroid Conditions

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The thyroid gland makes hormones that control metabolism, heart rate, body temperature, and other body functions. When it doesn’t work properly, children are at risk for delayed brain development, growth problems, weight problems, and early or delayed puberty. These long-term complications can be avoided when children are treated by specialists with a deep understanding of thyroid hormones. Duke’s pediatric endocrinologists manage thyroid disorders in children, including the most challenging thyroid conditions, such as indeterminate thyroid nodules and thyroid cancer. We also evaluate and monitor children who have rare genetic conditions that increase their risks for thyroid cancer.

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About Pediatric Thyroid Disorders

Duke’s pediatric endocrinologists care for infants, children, and teens with the following thyroid disorders.

Hypothyroidism (Underactive Thyroid)
This is when the thyroid gland doesn’t make enough thyroid hormone. Some children are born with a thyroid gland problem. Others develop autoimmune conditions, such as Hashimoto’s thyroiditis, that damage the thyroid gland.

Hyperthyroidism (Overactive Thyroid)
This is when the thyroid gland makes too much thyroid hormone. Types of hyperthyroidism include Graves’ disease, Hashitoxicosis, and an overactive thyroid nodule.

Goiter (Enlarged Thyroid Gland)
A goiter can indicate an underactive or overactive thyroid gland. In some cases, the gland grows so large that it causes breathing or swallowing problems.

Thyroid Nodules
These growths within the thyroid gland may be benign (noncancerous) or, less commonly, cancerous. Nodules can also be nonfunctioning, meaning they don’t produce hormones, or hyperfunctioning (they produce extra thyroid hormone).

Thyroid Cancer
Occurs when cancer cells grow in the cells of the thyroid gland. Types include papillary, follicular, and medullary thyroid cancers.

Genetic Conditions
Can increase a child’s risk of developing thyroid cancer. These include multiple endocrine neoplasia type 2 (MEN2), DICER1 syndrome, familial adenomatous polyposis (FAP), Gardner syndrome, Carney complex, Werner syndrome, and PTEN hamartoma tumor syndrome.

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Duke Health offers locations throughout the Triangle. Find one near you.


If your child’s thyroid hormone levels are abnormal, we’ll use different approaches to figure out why.

Physical Exam

Your doctor reviews your child’s history and feels the neck for signs of an enlarged thyroid, a thyroid nodule, or swollen lymph nodes.

Blood Tests

Blood tests help measure what’s happening inside your child’s body. By checking the levels of certain hormones, including T4, T3, thyroid stimulating hormone (TSH), and in some cases calcitonin, we can determine if the thyroid gland is working properly. Blood tests can also detect thyroid antibodies, which tells us if your child’s immune system is attacking or effecting the thyroid gland.

Genetic Tests

Genetic testing can determine if there are genetic mutations causing MEN2 or other conditions that increase your child’s risk of thyroid cancer.

Thyroid Ultrasound

This test uses sound waves to create pictures of the thyroid. Ultrasounds help confirm whether a lump in the neck is a thyroid nodule and whether the nodule has certain features that might be signs of cancer.

Radioactive Thyroid Scan

Healthy thyroid glands absorb iodine from the diet and use it to make thyroid hormones. During a thyroid scan, your child swallows (or is injected with) a tiny amount of radioactive iodine. A special machine that can see radioactive material helps show where thyroid tissue is located and if the thyroid gland is working properly.


A pediatric radiologist uses a small needle to remove tissue from the thyroid gland, a thyroid nodule, or a lymph node. Pathologists analyze the tissue to see if it contains cancer cells.

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Treatments are selected to address your child’s individual needs and the nature of your child’s thyroid condition. Our goal is to restore your child’s hormone levels to normal in order to alleviate symptoms and prevent complications. In addition to providing the highest quality of medical and surgical care, we also attend to your child’s and your family’s psychosocial concerns.


In most cases, hypothyroidism can be safely and successfully managed with a daily dose of synthetic thyroid hormone. Hyperthyroidism may be treated with anti-thyroid medication, which prevents the thyroid from producing hormones. Children with an overactive thyroid may also need to take beta-blockers to reduce heart rate, blood pressure, agitation, and tremor until thyroid hormone levels are under control.

Radioactive Iodine Ablation

In some cases, a child may be intentionally given oral doses of radioactive iodine that are high enough to destroy the thyroid gland. This is a permanent treatment option for children whose overactive thyroid cannot be managed with medication. In children with thyroid cancer, this treatment may be used after surgery to destroy any lingering cancer cells. Once the thyroid gland is destroyed, your child will take a daily dose of synthetic thyroid hormone that will ensure normal growth, development, and long-term reproductive function.


Surgery may be used to remove part of the thyroid gland (lobectomy) or the entire gland (total thyroidectomy). This may be necessary to remove a large goiter causing symptoms, thyroid nodules that are overactive, or thyroid cancer. If the entire gland is removed, your child will take a daily dose of synthetic thyroid hormone that will maintain normal thyroid function.

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Duke Children's Hospital & Health Center is proud to be nationally ranked in 10 pediatric specialties.

Why Choose Duke

A Team Approach to Comprehensive Thyroid Treatment
The Duke Pediatric Comprehensive Thyroid Clinic, established in 2018, was the first clinic in the region to create a multidisciplinary team that specializes in the treatment of pediatric thyroid nodules and thyroid cancer. Team members will vary based on your child’s thyroid condition. Underactive thyroid (hypothyroidism) will often be treated by the pediatric endocrinologist alone. Overactive thyroids (such as Graves’ disease) and thyroid nodules and thyroid cancers, will be treated by multiple team members, led by the pediatric endocrinologist. Your child’s team may include specialists in endocrinology, radiology, endocrine surgery, head and neck surgery, anesthesiology, oncology, nuclear medicine, and genetics. Team members have extensive experience caring for children with thyroid disorders.

Expert Care for Pediatric Eye Problems
About one-third of children with Graves’ disease develop eye problems such as changes to the appearance of the eyes (more prominent or bulging eyes), dry eyes, and eye discomfort. When this occurs, our pediatric ophthalmologists provide expert care to your child.

Experienced Surgeons Reduce Your Child’s Risk of Complications
Our endocrine surgeon perform hundreds of thyroidectomies annually. Research shows that having an experienced thyroid surgeon reduces the risk of complications and leads to better outcomes.

Pediatric-Specific Treatment Guidelines
We use pediatric-specific guidelines to treat thyroid nodules and thyroid disorders. That’s because these conditions can behave differently in children, and aggressive treatments geared for adults can cause long-term complications in children. To stay up-to-date on the latest pediatric treatments, we are active members of the American Thyroid Association and Pediatric Endocrine Society. 

Research-Driven Care
Our pediatric endocrinologists are also researchers who are dedicated to improving care for children with thyroid conditions. We are members of the Child and Adolescent Thyroid Consortium (CATC), a collaborative research effort across multiple institutions to improve the care of children with thyroid cancer. Our multidisciplinary research team at Duke Health also studies noninvasive methods of diagnosing pediatric thyroid cancer using artificial intelligence.

This page was medically reviewed on 05/29/2023 by