pediatrics
Hyperthyroidism in Infants and Children
Key Points
Hyperthyroidism in infants is usually caused by transplacental thyroid-stimulating antibodies from pregnant women with Graves disease. Hyperthyroidism in older children and adolescents is usually caused by Graves disease. There are numerous manifestations of hyperthyroidism, including tachycardia, hypertension, weight loss, irritability, decreased concentration and school performance, and sleep difficulties. Diagnosis is with serum free thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone (TSH); thyroid-stimulating immunoglobulins (TSI) can be used to confirm Graves disease. If there are significant palpable abnormalities of the thyroid, do ultrasonography. Treat withmethimazoleand, for symptoms, a beta-blocker; however, only about 35% of cases acquired outside the neonatal period resolve with antithyroid drugs and patients may need definitive therapy using radioactive iodine or surgery. 