Typical symptoms which should lead to suspicion of hyperthyroidism are unintentional weight loss, tachycardia, and palpitations, heat intolerance, and hyperactivity. It is diagnosed by suppressed thyroid-stimulating hormone (TSH) with elevated thyroid hormone (TH) levels. Graves’ disease (GD) due to antibodies stimulating the TSH receptor is the leading cause, and first-line treatment is with methimazole (MMI). Emerging data suggest MMI treatment, up to 8 years is effective and safe in improving the rate of remission. Radioactive iodine (RAI) and thyroidectomy offer definitive treatment and induce permanent hypothyroidism. Thyroid storm is a life-threatening condition with systemic decompensation and hyperpyrexia. Neonates of mothers with current or past GD are at risk for neonatal hyperthyroidism (NH). Appropriate identification and follow-up of at-risk neonates will reduce complications.
Key points
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Hyperthyroidism is diagnosed by elevated thyroid hormones (TH), Free T4 and total T3 and suppressed thyroid-stimulating hormone (TSH).
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Graves’ disease (GD), an autoimmune disorder makes up 96% of pediatric hyperthyroidism.
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Hyperthyroidism is a hypermetabolic state with cardiovascular, GI, neurologic, dermatologic, and ocular symptoms. Symptoms can also be misleading and point to other systemic disorders and delay diagnosis.
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First line of treatment of GD in children is with methimazole (MMI) while radioactive iodine (RAI) treatment and thyroidectomy offer permanent treatment and render patient hypothyroid.
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Neonates born to mothers with current or past treatment of GD are at risk for neonatal hyperthyroidism (NH).
An update on hyperthyroidism in children
Purpose of the review: This review is intended to highlight causes, enable early and accurate diagnosis and management of hyperthyroidism in children and neonates.
Introduction
Hyperthyroidism is due to increased production of thyroid hormone (TH) as noted biochemically by elevated TH, Free T4 and T3, and suppressed thyroid-stimulating hormone (TSH). The most common cause of hyperthyroidism is GD which is an autoimmune disorder from TSH receptor stimulation by TSH receptor antibody (TRAb) and makes up for 96% of pediatric hyperthyroidism [
]. GD is more common in females and may occur at any age during childhood, peaking during adolescence. A French population-based study [ ] in 2015 identified a total of 670 cases of childhood hyperthyroidism for an annual incidence of 4.58/100,000 person-years showing the rarity of the diagnosis, with a 3.27 F/M ratio. Only 10% were less than 5 years of age. In a study from Sweden [ ] incidence rate (IR) was higher from 2000 to 2009 versus 1990 to 1999 (2.8/100,000 vs 1.6/100,000 person-years, P = .006), suggesting that at least in some parts of the world the incidence of childhood hyperthyroidism is increasing. There is concern that increasing exposures to endocrine-disrupting chemicals may have caused the increase [ ] Hyperthyroidism is a hypermetabolic state with cardiovascular, GI, neurologic, dermatologic and ocular symptoms [ ]. Symptoms are gradual, and it may take months before families seek medical attention. Symptoms can also be misleading and point to other systemic disorders and delay diagnosis. It is important that pediatricians be aware of these diverse symptoms to facilitate early screening and referral to a pediatric endocrinologist for treatment.
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