Description
Hyperthyroidism in children, often linked to Graves' disease, is an autoimmune disorder affecting the thyroid gland. Graves' disease prompts the thyroid to produce excessive thyroid hormones, leading to hyperthyroidism. Common symptoms in children include weight loss, increased appetite, irritability, and accelerated growth. Unlike adults, children with Graves' disease may experience pronounced emotional and behavioral changes.
Physical manifestations can include enlarged thyroid (goiter), bulging eyes (exophthalmos), and skin changes. Diagnosis involves blood tests measuring thyroid hormone levels and thyroid-stimulating immunoglobulin (TSI). Treatment options include anti-thyroid medications, radioactive iodine therapy, or in some cases, surgical intervention. Monitoring growth and development is crucial to adjust treatment and manage potential side effects.
Close collaboration between pediatric endocrinologists and other healthcare professionals is essential for comprehensive care. With appropriate treatment, children with Graves' disease can lead normal, healthy lives. Regular follow-ups ensure optimal thyroid function and overall well-being.
Résumé
- Hyperthyroidism in children is rare, characterized by excessive thyroid hormones leading to accelerated metabolism. The most common cause (95%) is Graves' disease, an autoimmune disorder where antibodies stimulate thyroid follicular cells. Other causes include TSH-producing pituitary adenomas, toxic adenomas, and thyroiditis.
- Graves' disease, named after Robert Graves, is an immunogenetic disorder with thyromegaly, hyperthyroidism, and infiltrative ophthalmopathy. Clinical features include goiter, tachycardia, nervousness, weight loss despite increased appetite, tremors, and heat intolerance. Complications include thyroid storm and thyrotoxic periodic paralysis.
- Graves' ophthalmopathy, affecting over 50% of children with Graves', presents with lid lag, lid retraction, stare, proptosis, conjunctival injection, and periorbital edema. Pathogenesis involves autoimmune antibodies against orbital fibroblasts, leading to lymphocytic infiltration and glycosaminoglycans accumulation. Management includes eye drops, head elevation, corticosteroids, and surgical decompression in severe cases.
- Diagnosis involves thyroid function tests showing suppressed TSH and elevated free T4 and/or T3. Measurement of TSH receptor antibodies (TRAb) is important. Radioactive iodine uptake scans differentiate Graves' from thyroiditis, with elevated uptake in Graves'. Treatment options include antithyroid drugs (methimazole), radioactive iodine ablation, and thyroidectomy.
- Methimazole, the preferred antithyroid drug in children, interferes with iodination of tyrosin residues. Common side effects include hepatitis and agranulocytosis. Monitoring requires regular thyroid function tests. Beta-adrenergic blockers like propranolol manage symptoms like tremors and tachycardia.
- Neonatal Graves' disease occurs when maternal TRAb cross the placenta, affecting the fetal thyroid. Clinical presentation includes fetal tachycardia, goiter, IUGR, and prematurity. Postnatally, babies may exhibit tachycardia, hyperexcitability, poor weight gain, and exophthalmia. Diagnosis involves maternal antibody determination and fetal ultrasound. Treatment involves methimazole, propranolol, and potassium iodide.
Exemple de certificat
À propos des intervenants
Dr Tejasvi Sheshadri
Consultant Paediatric Endocrinologist, Sparsh Hospitals, Bangalore
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