Hyperthyroidism

Hyperthyroidism

usually results from Grave's disease (autoimmune thyroiditis)
1. secondary to production of thyroid stimulating Ig (TSIs)
most often seen in teenage girls
clinical features
1. similar to adults
  1. but eye signs uncommon in kids
2. systemic
  1. anxiety, restlessness
  2. increased appetite
  3. sweating
  4. diarrhoea
  5. weight loss
  6. rapid growth in height
  7. advanced bone maturity
  8. tremor
  9. tachycardia, wide pulse Pa
  10. warm, vasodilated peripheries
  11. goitre (bruit)
  12. learning difficulties/behavioural probs
  13. psychosis
3. eye signs
  1. exophthalmos
  2. ophthalmoplegia
  3. lid retraction
  4. lid lag
Ix
1. thyroxine (T4) &/or tri-iodothyronine (T3) levels elevated
2. TSH levels suppressed to very low
3. Antithyroid peroxismal antibodies may also be present
  1. can -> spontaneous resolution of thyrotoxicosis
    1. but subseq cause hypothyroidism (called hashitoxicosis)
Mx
1. medical Rx
  1. 1st line
    1. drugs interfering w/ thyroid hormone synthesis
      1. carbimazole
      2. thyrouracil
      3. risk of neutropenia
        advise fam to seek urgent help & blood count
        if sore throat and high fever occur on starting Rx
      4. given for 2 years
        control thyrotoxicosis
        eye signs may not resolve
        75% relapse when meds stopped
        2nd course of meds or surgery (subtotal thyroidectomy)
        -> permanent remission
  2. beta blockers
    1. symptomatic relief of
      1. tremor
      2. anxiety
      3. bradycardia
    2. initially
2. radioiodine
3. always follow up
  1. thryoxine replacement often needed for subseq hypothyroidism
neonatal hyperthyroidism
1. occurs in infants of mums w/ Grave's
  1. from transplancental transfer of TSIs
2. Rx required
  1. potentially fatal
    1. but it resolves spontaneously with time

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	Created by v.djabatey over 10 years ago