Thyrotoxicosis (3)

Question 1

What are most cases caused by?

What causes Neonatal Grave’s?

How does it present?

Answer 1

➊ Grave’s disease

➋ Placental passage of maternal Anti-thyroid Ab’s

➌ • Weight loss
• Restlessness
• Excessive sweating
• Diarrhoea, Frequent changing of nappies
• Poor sleep
• Tachycardia
• Enlarged, smooth, firm, non-tender thyroid
• In older children, they may present similarly to ADHD – Hyperthyroidism should be part of investigations in any child who’s presentation suggests ADHD

Question 2

What’s the 1st line management option?
→ What is an important side-effect to avoid here?

What are the other options?
→ What are the complications of surgery?

Answer 2

➊ Antithyroid drugs – Carbimazole, Methimazole
→ Hypothyroidism

➋ • Radioactive Iodine – Usually delayed until adolescence
• Surgery
→ • Hypoparathyroidism (Hypocalcaemia)
• Recurrent laryngeal nerve damage (Vocal cord paralysis, hoarse voice)