Chapter 28 HYPERTHYROIDISM Timothy J. Horita General Discussion Although numerous conditions can lead to overproduction of thyroid hormone (hyperthyroidism), it is fairly uncommon in the pediatric population. Most cases are due to autoimmune pathology. In the neonate born to a mother with hyperthyroidism, signs and symptoms may be noticed before birth or several days into life. Graves’ disease accounts for most pediatric cases, along with toxic (uninodular or multinodular) goiter and inflammatory conditions such as thyroiditis. Although a goiter is usually present, it may be difficult to detect on a screening examination. Other signs and symptoms of hyperthyroidism are usually quite evident. Thyroid hormone, with its many physiologic actions, often produces a state similar to sympathetic overstimulation. In noncongenital cases, symptoms are most commonly detected in the early teens, and much more commonly in girls. The initial work-up for a child with suspected hyperthyroidism is fairly straightforward. Referral to a pediatric endocrinologist is often very helpful in co-management. Medications Associated with Hyperthyroidism • Dessicated thyroid extract (factitious hyperthyroidism) • Levothyroxine sodium (factitious hyperthyroidism) • Liothyronine sodium (factitious hyperthyroidism) • Liotrix (factitious hyperthyroidism) • Methimazole (may cross placenta) • Propylthiouracil (may cross placenta) Causes of Hyperthyroidism • Autoimmune acute thyroiditis • Congenital • Factitious hyperthyroidism • Graves’ disease • Infectious acute thyroiditis • Iodine ingestion/toxicity • McCune-Albright syndrome • Pituitary resistance to thyroid hormone • Subacute thyroiditis • Thyroid binding globulin deficiency • Thyroid carcinoma • Toxic uninodular goiter (thyroid adenoma) • Toxic multinodular goiter • Thyroid-stimulating hormone (TSH)-secreting pituitary tumor Key Historical Features Symptoms of Hyperthyroidism • Anxiety • Irritability • Excessive nervousness • Excessive sweating • Palpitations Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Diarrhea, acute Abnormal head size and shape Musculoskeletal pain Seizures Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Pediatrics Jun 18, 2016 | Posted by admin in PEDIATRICS | Comments Off on Hyperthyroidism Full access? Get Clinical Tree
Chapter 28 HYPERTHYROIDISM Timothy J. Horita General Discussion Although numerous conditions can lead to overproduction of thyroid hormone (hyperthyroidism), it is fairly uncommon in the pediatric population. Most cases are due to autoimmune pathology. In the neonate born to a mother with hyperthyroidism, signs and symptoms may be noticed before birth or several days into life. Graves’ disease accounts for most pediatric cases, along with toxic (uninodular or multinodular) goiter and inflammatory conditions such as thyroiditis. Although a goiter is usually present, it may be difficult to detect on a screening examination. Other signs and symptoms of hyperthyroidism are usually quite evident. Thyroid hormone, with its many physiologic actions, often produces a state similar to sympathetic overstimulation. In noncongenital cases, symptoms are most commonly detected in the early teens, and much more commonly in girls. The initial work-up for a child with suspected hyperthyroidism is fairly straightforward. Referral to a pediatric endocrinologist is often very helpful in co-management. Medications Associated with Hyperthyroidism • Dessicated thyroid extract (factitious hyperthyroidism) • Levothyroxine sodium (factitious hyperthyroidism) • Liothyronine sodium (factitious hyperthyroidism) • Liotrix (factitious hyperthyroidism) • Methimazole (may cross placenta) • Propylthiouracil (may cross placenta) Causes of Hyperthyroidism • Autoimmune acute thyroiditis • Congenital • Factitious hyperthyroidism • Graves’ disease • Infectious acute thyroiditis • Iodine ingestion/toxicity • McCune-Albright syndrome • Pituitary resistance to thyroid hormone • Subacute thyroiditis • Thyroid binding globulin deficiency • Thyroid carcinoma • Toxic uninodular goiter (thyroid adenoma) • Toxic multinodular goiter • Thyroid-stimulating hormone (TSH)-secreting pituitary tumor Key Historical Features Symptoms of Hyperthyroidism • Anxiety • Irritability • Excessive nervousness • Excessive sweating • Palpitations Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Diarrhea, acute Abnormal head size and shape Musculoskeletal pain Seizures Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Pediatrics Jun 18, 2016 | Posted by admin in PEDIATRICS | Comments Off on Hyperthyroidism Full access? Get Clinical Tree
