Hyperthyroidism in Children: Model Clinical Case and Viva Q&A

Clinical Case of Hyperthyroidism in Children

Sarah, a 12-year-old female, presents to the pediatric endocrinology clinic with complaints of weight loss, increased appetite, and difficulty concentrating in school. Her parents report that she has become increasingly irritable and anxious over the past three months. They've also noticed that Sarah seems to be sweating more than usual, even in cool environments.

On physical examination, the following findings are noted:

• Height: 75th percentile
• Weight: 25th percentile (down from 50th percentile 6 months ago)
• Heart rate: 110 bpm
• Blood pressure: 130/80 mmHg
• Skin: warm and moist
• Thyroid: diffusely enlarged, approximately 40 grams
• Eyes: mild proptosis
• Hands: fine tremor

Laboratory tests reveal:

• TSH: <0.01 mIU/L (normal range: 0.4-4.0)
• Free T4: 3.8 ng/dL (normal range: 0.8-1.8)
• Free T3: 12 pg/mL (normal range: 2.3-4.2)
• TSH receptor antibodies: positive

Based on these findings, Sarah is diagnosed with Graves' disease, the most common cause of hyperthyroidism in children. She is started on methimazole and propranolol, with close follow-up scheduled to monitor her response to treatment and adjust medication as needed.

Clinical Presentations of Hyperthyroidism in Children

1. Classical Graves' Disease Presentation

   • Goiter
   • Exophthalmos (bulging eyes)
   • Tachycardia
   • Weight loss despite increased appetite
   • Heat intolerance and increased sweating
   • Tremors
   • Hyperactivity and difficulty concentrating

2. Thyrotoxic Crisis (Thyroid Storm)

   • High fever (>40°C)
   • Severe tachycardia or atrial fibrillation
   • Vomiting and diarrhea
   • Dehydration
   • Altered mental status or agitation
   • Possible congestive heart failure

3. Prepubertal Presentation

   • Accelerated growth and bone maturation
   • Early onset of puberty
   • Attention deficit and poor school performance
   • Mild weight loss or failure to gain weight appropriately

4. Neonatal Graves' Disease

   • Prematurity
   • Intrauterine growth restriction
   • Goiter
   • Tachycardia
   • Hepatosplenomegaly
   • Thrombocytopenia
   • Craniosynostosis

5. Apathetic Hyperthyroidism

   • Fatigue and weakness
   • Depression
   • Weight loss
   • Minimal to no goiter
   • Subtle eye signs

6. Thyrotoxic Periodic Paralysis

   • Sudden onset of muscle weakness or paralysis
   • Hypokalemia
   • More common in adolescent males of Asian descent

7. Ocular Predominant Presentation

   • Severe exophthalmos
   • Periorbital edema
   • Corneal ulceration
   • Optic nerve compression
   • Minimal systemic symptoms

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.