pediatrics
Hyperthyroidism in Infants and Children
Symptoms and Signs
 hyperthyroidism is rare. Signs of hyperthyroidism (eg, poor intrauterine growth, fetal tachycardia [> 160 beats/minute], goiter) may be detected as early as the second trimester. Fetal hyperthyroidism may cause preterm labor. If fetal thyrotoxicosis is noted, the mother can be treated with antithyroid drugs. If fetal hyperthyroidism is not detected until the neonatal period, the infant may be severely affected; possible manifestations include Craniosynostosis (premature fusion of the cranial sutures), impaired intellect, growth failure, and short stature. Mortality rate may reach 10 to 15%. symptoms and signs of hyperthyroidism include irritability, feeding problems, hypertension, tachycardia, exophthalmos, goiter ( see Congenital Goiter ), frontal bossing, and microcephaly. Other early findings are failure to thrive, vomiting, and diarrhea. Affected infants almost always recover within 6 months; the course is rarely longer. The onset and severity of symptoms also vary depending on whether the mother is taking antithyroid drugs. If the mother is not taking drugs, infants are hyperthyroid at birth; if the mother is taking drugs, infants may not become hyperthyroid until the drugs are metabolized at about 3 to 7 days. More than 95% of children born to mothers with Graves disease present with symptoms within the first month of life; rarely, presentation is delayed into the second month. symptoms of acquired Graves disease may include sleep difficulties, hyperactivity, emotional lability, marked decrease in concentration and school performance, heat intolerance, diaphoresis, fatigue, weight loss, increased frequency of bowel movements, tremor, and palpitations. Signs include diffuse goiter, tachycardia, and hypertension. Graves ophthalmopathy occurs in up to one third of children. Although eye findings are less dramatic than in adults, children may have eyelid lag or red or prominent eyes, sometimes with Proptosis (exophthalmos). Children and adolescents may present with alterations in growth, including growth acceleration and advanced bone age. The onset and progression through puberty are usually not affected by hyperthyroidism, with the exception of oligomenorrhea or amenorrhea noted in some girls. Acute thyroiditismay occur at any age and manifests with sudden onset of symptoms of hyperthyroidism, tenderness over the thyroid gland, and fever. About 10% of patients with acute thyroiditis have hyperthyroidism. Many have leukocytosis with a left shift. In subacute thyroiditis these manifestations are present but less severe and may have been preceded by a viral illness; fever may last for several weeks. Thyroid storm , 