Hypothyroidism in Children: Growth, Development, and the 'Cold Thyroid' Sensation

Pediatric hypothyroidism (congenital or acquired) causes:

• Growth failure – short stature, delayed bone age.
• Neurodevelopmental delay – if untreated in infancy → irreversible intellectual disability.
• Myxedema: Puffy face, coarse hair, dry skin, constipation, cold intolerance, bradycardia.
• Muscle: Hypotonia, weakness, delayed reflexes (hung-up reflexes).

"Cold thyroid" (cool skin) reflects peripheral vasoconstriction from low metabolic rate and reduced thermogenesis, not a primary thyroid sign. It can also occur in euthyroid individuals with autonomic dysfunction, malnutrition, or aging.

Screening & Treatment

• Newborn screen (TSH/T4) – critical for congenital hypothyroidism.
• Levothyroxine weight-based dosing; monitor TSH/free T4 q1–3 months.