Paediatric Thyroid Disease

Thyrotoxicosis

• Occasionally presents in adolescents, usually due to Graves’ disease
• 1-2% of cases present as severe acute thyrotoxicosis
• Other causes include thyroiditis, iodin—induced hyperthyroidism, TSH hypersecretion, thyroid hormone ingestion and thyroid neoplasms
• Hyperthyroidism seen in McCune-Albright syndrome
• Presentation
  • High fever, marked tachycardia, HTN, tremor, sweating, muscle weakness, altered mental status, seizures, coma
  • Graves’ will have diffuse, non-tender goitre

• Diagnosis
  • Low TSH and raised T3/4
• Treatment
  • ABCDE
  • Beta-blockers for initial control of symptoms: Propranolol 2-4mg/kg/day in 2 divided doses +- IV therapy initially
  • Propylthiouracil and/or carbimazole antithyroid medications in concert with endocrine team

Neonatal thyrotoxicosis

• Rare condition due to placental transfer of thyroid-stimulating antibodies from mother with autoimmune hyperthyroidism
• Importantly, mother may have no symptoms of hyperthyroidism
• Poor weight gain, cardiac dysfunction, hepatosplenomegaly may arise
• Cardiac failure and airway compression due to goitre may occur
• Onset may be delayed if mother is on antithyroid medications
• Most cases resolve spontaneously but condition associated with significant morbidity and mortality

Hypothyroidism

• Congenital hypothyroidism
  • May be due to anatomical defects, inborn error of thyroid metabolism or maternal iodine deficiency (Cretinism)
  • Crucial for brain development
  • Suggestive symptoms/signs include poor feeding/developmental/growth, constipation, umbilical hernia, enlarged fontanelle, enlarged tongue, hypotonia, hoarse cry, bradycardia/cool extremities
• Hashimoto’s thyroiditis
  • Can arise in adolescents
  • May present with weakness, lethargy, weight gain, cold intolerance, constipation, depression, poor concentration, hoarse/husky voice, goitre, menorrhagia, bradycardia or hypothermia

Last Updated on November 22, 2021 by Andrew Crofton