Hyperthyroidism (Thyrotoxicosis)

Question 1

What is thyrotoxicosis?

Answer 1

A hypermetabolic state caused by elevated circulating thyroid hormones.

Question 2

What is the most common cause of hyperthyroidism in children?

Answer 2

Graves’ Disease, an autoimmune disorder with TSH receptor autoantibodies.

Question 3

Name other causes of hyperthyroidism besides Graves’ Disease.

Answer 3

Toxic multinodular goiter, toxic nodular goiter, exogenous thyroid hormone intake, iodine-induced thyrotoxicosis, thyroiditis, and rare TSH-secreting tumors.

Question 4

What are common symptoms of hyperthyroidism in children?

Answer 4

Nervousness, palpitations, weight loss despite increased appetite, fatigue, sleep disturbances, heat intolerance, tremor, diarrhea, dyspnea.

Question 5

What physical signs may indicate hyperthyroidism?

Answer 5

Thyroid enlargement, possible bruit, eye changes (ophthalmopathy), lid lag, lid retraction, proximal muscle weakness, onycholysis.

Question 6

What cardiovascular effects are associated with hyperthyroidism?

Answer 6

Tachycardia, atrial fibrillation, and potential cardiac failure, particularly in those with underlying heart conditions.

Question 7

What is a thyroid storm, and why is it critical in hyperthyroidism management?

Answer 7

A life-threatening condition of severe hyperthyroidism that may occur in ICU settings or untreated cases, requiring immediate intervention.

Question 8

What are potential respiratory risks associated with hyperthyroidism?

Answer 8

Edema of the upper airway due to large goiters.

Question 9

How is hyperthyroidism diagnosed in pediatric patients?

Answer 9

Laboratory findings of increased serum T3 and/or T4, low or undetectable TSH, except in TSH-secreting tumors.

Question 10

What is the first-choice antithyroid medication for children?

Answer 10

Methimazole, due to its safety profile.

Question 11

What is the initial dose of Methimazole for pediatric patients?

Answer 11

Typically 0.4-0.6 mg/kg/day divided into two to three doses, adjusted based on response.

Question 12

Why is Propylthiouracil (PTU) generally avoided in children?

Answer 12

Due to severe liver toxicity risks.

Question 13

How are beta-blockers used in hyperthyroidism management?

Answer 13

Propranolol is used to manage symptoms, especially cardiovascular symptoms, with dosing of 2 mg/kg/day divided every 6-12 hours.

Question 14

When is radioactive iodine therapy considered for hyperthyroidism?

Answer 14

For older children and adolescents who fail medical management or experience severe side effects.

Question 15

When is surgical intervention indicated in hyperthyroidism?

Answer 15

In cases of large goiters, severe ophthalmopathy, or lack of response to medical treatments.

Question 16

How often should thyroid function tests be performed during treatment?

Answer 16

Regularly after treatment initiation and during follow-up.

Question 17

What is the typical duration of medical treatment for hyperthyroidism before considering remission?

Answer 17

Approximately 2 years.

Question 18

How should hyperthyroidism medications be managed in ICU patients with feeding difficulties?

Answer 18

Ensure continuity via oral, nasogastric, or rectal administration.

Question 19

What is the role of a PICU fellow in managing thyroid storm?

Answer 19

Provide acute management, monitor vital signs, and ensure timely medication administration.

Question 20

What specialists should a PICU fellow collaborate with in complex hyperthyroidism cases?

Answer 20

Endocrinologists, surgeons, and other specialists.

Question 21

Why is patient and family education important in hyperthyroidism management?

Answer 21

To ensure adherence to treatment and understanding of potential side effects and complications.

Question 22

What laboratory findings suggest a TSH-secreting pituitary adenoma?

Answer 22

High T3 and/or T4 with elevated or inappropriately normal TSH.

Question 23

What are the key symptoms of ophthalmopathy in Graves’ Disease?

Answer 23

Eye changes such as lid retraction, lid lag, and possible exophthalmos.

Question 24

What dose range of Propranolol is typically used for symptomatic relief in hyperthyroidism?

Answer 24

10-40 mg per dose (2 mg/kg/day) orally divided every 6-12 hours.

Question 25

What are the risks of untreated severe hyperthyroidism in children?

Answer 25

Thyroid storm, cardiac failure, respiratory compromise from goiter-induced airway edema.