Hyperthyroidism is excessive thyroid hormone production. The diagnosis is made (eg. As free serum thyroxine, TSH) due to the thyroid hormone determination. Treatment is with methimazole and sometimes with radioactive iodine or surgery.
Hyperthyroidism is excessive thyroid hormone production. The diagnosis is made (eg. As free serum thyroxine, TSH) due to the thyroid hormone determination. Treatment is with methimazole and sometimes with radioactive iodine or surgery. Etiology Hyperthyroidism occurs rarely in infants, but is potentially life threatening. It develops in fetuses of women with existing, or previously, Graves ‘disease (thyroid disease in pregnancy: Graves’ disease). In Graves’ disease patients have autoantibodies to the thyroid receptor for thyroid-stimulating hormone (TSH), and these autoantibodies overstimulate the thyroid hormone production by binding to TSH receptors in the thyroid. These antibodies can cross the placenta and cause hyperthyroidism in the fetus (intrauterine Graves’ disease), which can lead to fetal death or premature birth. Because the antibodies diminish in the infants after birth, the hyperthyroidism is passager. Since the time until the antibody disappears from the serum are varied, and the duration of hyperthyroidism can be of different lengths. In children and adolescents Graves’ disease is the cause of hyperthyroidism in> 90%. Among the less common causes include autonomously functioning toxic nodules, transient hyperthyroidism during the early stages of Hashimoto’s thyroiditis (Hashimoto’s thyroiditis), to finally hypothyroidism follows (Hashitoxikose) or adverse drug reactions (eg. As amiodarone-induced hyperthyroidism). Occasionally transient hyperthyroidism can be caused by infections, including bacterial (acute thyroiditis) and viral (subacute thyroiditis Subacute Thyroiditis-) infections. Prepubertal children face often with isolated Trijodthyronin- (T3) -Toxikose before, but if the diagnosis is delayed, they may have high levels of free thyroxine (T4) in serum and high antibody directed against the TSH receptor have. Symptoms and signs Symptoms include irritability in infants, feeding problems, hypertension, tachycardia, exophthalmos, goiter (Congenital goiter), frontal frontal protuberances and microcephaly one. Early signs are failure to thrive, vomiting and diarrhea. The affected children recover usually within 6 months, often it takes longer. The onset and severity of symptoms also vary depending on whether the mother takes anti-thyroid drugs. If the mother takes no medications that have infants at birth hyperthyroidism; if the mother takes drugs that infants may have no hyperthyroidism before the drugs are metabolized by about 3 to 7 days. Signs of hyperthyroidism (eg. As poor intrauterine growth, fetal tachycardia [> 160 beats / min], goiter) can be detected from the second trimester fetus may already be. If a fetal hyperthyroidism is not detected before the neonatal period, the child may be seriously affected; the possible manifestations include craniosynostosis (premature fusion of Schädelnahten- congenital craniofacial malformations: craniosynostosis), impaired intellect, growth disorders and short stature. Mortality can reach 10-15%. In children and adolescents, the symptoms of Graves’ disease acquired insomnia, hyperactivity, emotional lability, significant decrease in concentration and decrease in school performance, heat intolerance, sweating, fatigue, weight loss, increased frequency of bowel movements, tremors and palpitations may include. The signs include diffuse goiter, tachycardia and hypertension. Although the eye findings are less dramatic than in adults, children can have eyelid delay or red or protruding eyes, sometimes with proptosis (Exophthalmos- Proptosis). Prepubertal children are diagnosed rather delayed, leading to more chronic manifestations (eg. B. ahead paced bone age, increased body size, lower weight). Although they may have an increased frequency of bowel movements, they have not the heart palpitations or heat intolerance, which is common in Graves’ disease usually. Acute thyroiditis can manifest itself with a sudden onset of symptoms of hyperthyroidism, tenderness over the thyroid and fever. In subacute thyroiditis these manifestations are present, but less severe, and may be preceded by a viral disease; The fever may last for several weeks. Thyroid storm (hyperthyroidism: Thyrotoxic crisis), a rare, serious complication in children with hyperthyroidism, can manifest itself with extreme tachycardia, hyperthermia, hypertension, heart failure and delirium progresses to coma and death. Diagnosis Thyroid function tests Sometimes thyroid ultrasonography or radionuclide scan The diagnosis is suspected in infants whose mothers suffer from an active Graves ‘disease or have a history of Graves’ disease and have high titers TSI. It is confirmed by determining T4, T3 and TSH. The diagnosis in older children and adolescents is similar to that found in adults and includes functional tests of the thyroid one (hyperthyroidism: Diagnosis). T3 levels help in screening for an isolated T3 toxicosis. Many doctors perform a thyroid sonography in older children with Graves’ disease and thyroid imbalance or a palpable nodules. If a nodule is confirmed, a fine needle aspiration biopsy and a radionuclide scan (either 99mTc-pertechnetate or 123I) should be taken into consideration in order to exclude an autonomously functioning toxic nodules or simultaneous differentiated thyroid cancer. Treatment antithyroid drugs Sometimes radioactive iodine or surgery to treat the symptoms get the babies antithyroid typically Thiamazole from 0.17 to 0.33 mg / kg p.o. 3 times a day, sometimes together with a ?-blocker (eg. B. Propranolol 0.8 mg / kg po 3 times daily, atenolol 0.5-1.2 mg / kg po 1 time to 2 times a day ). It was recently discovered that propylthiouracil, another Thyreostatikum, sometimes leading to severe liver failure, and there is therefore no longer recommended as a drug of choice, but can in special situations such. B. thyroid storm can be used. The treatment should be closely monitored. It can be terminated immediately if the disease has run its course. (For the treatment of Graves ‘disease in pregnancy, thyroid disease during pregnancy. Graves’ disease) in older children and adolescents, the treatment of those in adults (hyperthyroidism therapy) is similar and includes antithyroid drugs and sometimes a definitive therapy with Schilddrüsenablation using radioactive iodine or surgery. ?-blockers, z. As atenolol or propranolol, can be used to control hypertension and tachycardia. Children who are treated with anti-thyroid drugs have a 30% remission probability that is lower than in adults (50%). A definitive therapy, in patients who reach 18 to 24 months of treatment with antithyroid no remission, have the side effects of the drugs or do not comply with the treatment may be required. Properties that are associated with a lower reflectance likelihood include younger age at onset (z. B. prepubertal vs. adolescent), higher thyroid hormone levels in the onset, larger thyroid (> 2.5 times normal size for age) and persistent increase TSH receptor antibody titers. Both radioactive iodine and surgery are reliable options for definitive therapy with the goal of producing hypothyroidism. However, radioactive iodine is generally used not in children who are younger than 10 years and it is often not effective in larger glands. Therefore, an operation in children and adolescents who have these factors are preferred. If an autonomously functioning toxic nodule is detected, surgical excision is recommended in children and adolescents. Treatment of acute thyroiditis comprises oral or intravenous antibiotics (amoxicillin / clavulanic acid or cephalosporins for patients who are allergic to penicillin). Subacute thyroiditis is self-limiting and non-steroidal anti-inflammatory drugs are given for pain control. Antithyroid drugs are not indicated, but ?-blockers can be used when patients are symptomatic. Important points hypothyroidism in infants is usually caused by transplacental thyroid stimulating antibodies from mothers 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 disorders. The diagnosis is made with thyroxine in serum (T4), free T4, triiodothyronine (T3) and thyroid stimulating hormone (TSH); when significant palpable abnormalities of the thyroid are present, an ultrasound is performed. The treatment with methimazole and a ?-blocker for the symptoms; However, go only about 30% of the cases that have been acquired outside the neonatal period, with antithyroid back and the patient may require a definitive therapy with radioactive iodine or surgery.