Graves disease is the usual cause of hyperthyroidism, but growths (nodules) on or inflammation of the thyroid gland, drugs, and infections can be causes too.
Symptoms depend on the child's age but typically include speeding up of bodily functions.
The diagnosis is based on blood tests and imaging tests.
Treatment typically includes antithyroid drugs and beta-blockers.
The thyroid gland is an endocrine gland Endocrine Glands located in the neck. Endocrine glands secrete hormones into the bloodstream. Hormones Endocrine Function are chemical messengers that affect the activity of another part of the body.
The thyroid gland secretes thyroid hormone. Thyroid hormone controls the speed of the body's metabolism, including how fast the heart beats and how the body regulates temperature. If the thyroid gland produces too much thyroid hormone, these functions speed up.
Locating the Thyroid Gland
Hyperthyroidism can occur in a developing fetus or newborn or during childhood or adolescence.
Hyperthyroidism, or Graves disease in the newborn (neonatal Graves disease), is rare in newborns but is potentially fatal if not recognized and treated by a medical doctor who specializes in disorders of the endocrine glands in children (pediatric endocrinologist). This condition usually occurs if the mother has Graves disease during pregnancy or has been treated for it before pregnancy. In Graves disease Graves disease Thyroid disorders may be present before women become pregnant, or they may develop during pregnancy. Being pregnant does not change the symptoms of thyroid disorders. How the fetus is affected... read more , the mother’s body produces antibodies that stimulate her thyroid gland to produce increased amounts of thyroid hormone. These antibodies cross the placenta and also cause the fetus's thyroid gland to produce too much thyroid hormone, which can result in death of the fetus or premature birth Premature Newborn . Because newborns are no longer exposed to the mother's antibodies after birth, Graves disease in the newborn is usually temporary, but the duration varies.
Children and adolescents
The cause of hyperthyroidism in more than 90% of children and adolescents is Graves disease Down Syndrome (Trisomy 21) . The rate of Graves disease increases during puberty, and 80% of cases happen after 11 years of age. Many children with Graves disease have a family history of autoimmune thyroid disease or other autoimmune disorders. Children with Down syndrome Down Syndrome (Trisomy 21) are at increased risk of Graves disease.
Less common causes of hyperthyroidism in children and adolescents include growths (nodules) on the thyroid gland, inflammation of the thyroid gland (Hashimoto thyroiditis Hashimoto Thyroiditis , in which hyperthyroidism is temporary and children eventually develop hypothyroidism Hypothyroidism in Infants and Children ), and some drugs. Occasionally, temporary hyperthyroidism can be caused by infections, including bacterial (acute thyroiditis) and viral (subacute thyroiditis Subacute Thyroiditis ) infections.
Symptoms of hyperthyroidism differ depending on the age of the child.
Symptoms of hyperthyroidism in fetuses may appear as early as the second trimester. Affected fetuses have poor growth, a very fast heart rate, and an enlarged thyroid gland (goiter Congenital Goiter ). If the disorder is present and untreated for a long period before birth, about 10 to 15% of newborns die and others have impaired intellectual development Intellectual Disability , poor growth, and short stature.
An affected newborn has increased bodily functions, such as a rapid heart rate and breathing, irritability, and excessive appetite with poor weight gain. Other symptoms include failure to thrive Failure to Thrive , vomiting Vomiting in Infants and Children , and diarrhea Diarrhea in Children . The newborn, like the mother, may have bulging eyes Eyes, Bulging (exophthalmos). If the newborn has an enlarged thyroid gland (congenital goiter Congenital Goiter ), the gland may press against the windpipe and interfere with breathing at birth. A very rapid heart rate can lead to heart failure.
Children and adolescents
Symptoms of hyperthyroidism reflect the speeding up of bodily functions:
Increased heart rate and blood pressure
Frequent bowel movements
Although bodily functions increase, concentration and school performance decrease. Goiter may be present. Children may have red or bulging eyes.
Symptoms of acute thyroiditis develop suddenly. Children have tenderness over the thyroid gland, and fever. In subacute thyroiditis, these symptoms are present but are less severe and may begin after a viral illness. Fever may last for several weeks.
Complications of hyperthyroidism
Thyroid storm Thyroid storm Hyperthyroidism is overactivity of the thyroid gland that leads to high levels of thyroid hormones and speeding up of vital body functions. Graves disease is the most common cause of hyperthyroidism... read more is a rare, severe complication of hyperthyroidism and a life-threatening emergency. In thyroid storm, the thyroid gland becomes suddenly and extremely active. All body functions are accelerated to dangerously high levels. Symptoms in affected children include an extremely fast heart rate, high body temperature, high blood pressure, heart failure, and changes in mental status. Thyroid storm can lead to coma and death.
Thyroid function tests
Sometimes imaging tests
In newborns, doctors suspect hyperthyroidism if the mother has active Graves disease or a history of Graves disease and high levels of thyroid-stimulating antibodies. The results of the routine screening blood test done in the hospital after birth to evaluate thyroid function, which is done mainly to look for hypothyroidism, may reveal hyperthyroidism in the newborn. To confirm the diagnosis, doctors do tests to determine levels of thyroid hormones in the blood (thyroid function tests Thyroid function tests The thyroid is a small gland, measuring about 2 inches (5 centimeters) across, that lies just under the skin below the Adam’s apple in the neck. The two halves (lobes) of the gland are connected... read more ). After hyperthyroidism of the newborn is diagnosed, doctors may do imaging tests to evaluate the size and location of the thyroid gland.
In older children and adolescents, doctors do thyroid function tests Thyroid function tests The thyroid is a small gland, measuring about 2 inches (5 centimeters) across, that lies just under the skin below the Adam’s apple in the neck. The two halves (lobes) of the gland are connected... read more . Biotin is a common over-the-counter supplement that can interfere with thyroid function tests by causing false readings of certain hormones. Use of biotin should be stopped for at least 2 days before tests are done.
Doctors also do ultrasonography Ultrasonography on older children who have Graves disease if the thyroid gland feels asymmetric or they feel a growth (nodule) on the thyroid gland. Computed tomography Computed Tomography (CT) (CT) or ultrasonography may also be done if doctors suspect a pocket of pus (abscess) or birth defect. If a nodule is found during ultrasonography, doctors remove a piece of it using a needle (called fine-needle aspiration biopsy) to determine whether the child has thyroid cancer. Doctors may also do an imaging test called radionuclide scanning Radionuclide Scanning to evaluate a nodule.
Newborns who developed hyperthyroidism as a fetus may be severely affected if hyperthyroidism is not detected until birth. The space between their skull bones may close too soon (called craniosynostosis Craniosynostosis ), and they may have intellectual disability, growth failure, and short stature. About 10 to 15% of newborns may die.
Newborns who have neonatal Graves disease almost always recover within 6 months. If the mother did not take drugs that decrease the thyroid gland's production of thyroid hormones (antithyroid drugs) while pregnant, the newborn will have hyperthyroidism at birth. If the mother did take the drugs while pregnant, the newborn may not show symptoms of hyperthyroidism for about 3 to 7 days after birth. (See also treatment of Graves disease during pregnancy Graves disease Thyroid disorders may be present before women become pregnant, or they may develop during pregnancy. Being pregnant does not change the symptoms of thyroid disorders. How the fetus is affected... read more .)
Older children who have Graves disease may respond to antithyroid drugs. They may need additional treatments to permanently treat the disorder if antithyroid drugs are not effective or if symptoms return.
Sometimes iodine or hydrocortisone
Children of all ages, including newborns, are given antithyroid drugs (such as methimazole), which decrease the thyroid gland's production of thyroid hormones, and beta-blockers (such as propranolol), which are drugs that slow the heart rate. Beta-blockers are used only if the heart rate is too fast or blood pressure is too high. Treatment with beta-blockers is stopped after the antithyroid drugs have taken effect.
Newborns may also be given drops of iodine by mouth or hydrocortisone by vein if other therapies have not helped. These drugs are stopped as soon as the antibodies that cross the placenta from the mother have disappeared from the newborn’s bloodstream. Infants treated with antithyroid drugs must be monitored closely to ensure that treatment does not cause hypothyroidism Hypothyroidism in Infants and Children , which can affect growth and development.
Newborns who have neonatal hyperthyroidism almost always recover by 6 months and no longer need antithyroid drugs. Symptoms in older children treated with antithyroid drugs may eventually disappear (called remission), but symptoms may return (called relapse) in some children and they may need further treatment.
Children who have a complication called thyroid storm may be given iodine drops by mouth or hydrocortisone by vein, but thyroid storm is rare.
Sometimes older children (11 years of age and older) with Graves disease need additional treatments to permanently treat the disorder. Permanent treatment (definitive therapy) may be needed if the antithyroid drugs do not work (or the child does not take them) or if the drugs are causing serious side effects. In definitive therapy, the gland is destroyed with radioactive iodine or removed with surgery. However, radioactive iodine is usually not given to children who are under age 10 and is often not effective in people who have larger thyroid glands. Therefore, surgery may be done instead for children and adolescents who have these factors.
Nodules are removed surgically.
Acute thyroiditis is treated with antibiotics. Subacute thyroiditis is not treated with antibiotics, but nonsteroidal anti-inflammatory drugs (NSAIDs) are given for pain. Children are not given antithyroid drugs, but beta-blockers may be given.
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