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Good Morning and Welcome Applicants!

Good Morning and Welcome Applicants!. January 14, 2011. Thyrotoxicosis. Most common cause in children Graves Disease >95% Other Causes Early phase Hashimoto Hyperfunctioning thyroid nodule Pituitary resistance to thyroxine TSH secreting adenoma Factitious hyperthyroidism .

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Good Morning and Welcome Applicants!

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  1. Good Morning andWelcome Applicants! January 14, 2011

  2. Thyrotoxicosis • Most common cause in children • Graves Disease • >95% • Other Causes • Early phase Hashimoto • Hyperfunctioning thyroid nodule • Pituitary resistance to thyroxine • TSH secreting adenoma • Factitious hyperthyroidism

  3. Graves Disease • Autoimmune • HLA – A1, B8 & DR3 • 0.02% of children • Positive FH • Peak incidence • 11-15 years • Males vs Females • Females 6-8x greater

  4. Graves Disease • Antibodies • TSH receptor • Stimulating • Other autoimmune disorders • Type 1 DM • Hypoparathyroidism • Addison Disease • Myasthenia, periodic paralysis, vitiligo, pernicious anemia

  5. Hyperthyroidism • CV • Tachycardia • Palpitations • Widened pulse pressure • Overactive precordium

  6. Hyperthyroidism • Neuromuscular • Tremors • Shortened DTR relaxation • Fatigue • Proximal muscle weakness

  7. Hyperthyroidism • Other • Increased appetite • Weight loss • Diarrhea • Increased perspiration • Warmth • Heat intolerance • Tall • Menstrual irregularities

  8. Hyperthyroidism • Behavioral disturbances • More common in children • Decreased attention span • Difficulty concentrating • Emotional lability • Hyperactivity • Difficulty sleeping • Nervousness

  9. Graves Disease PE • Thyroid • Diffusely enlarged • Eyes • Proptosis or exophthalmos • Findings less common in children

  10. Graves Disease PE • Extremities • Pretibialmyxedema • Rare in children

  11. Lab Values • Free T4 • Elevated • TSH • Depressed or undetectable • Thyroid receptor antibodies

  12. Treatment • Antithyroid medications • Radioiodine ablation • Surgical thyroidectomy • Don’t forget symptomatic treatment

  13. Antithyroid Medications • Reduce hormone production and block its effect peripherally • Usually 1st line therapy • Prolonged treatment • 2-5y • May be stopped after prolonged euthyroidism • 30-40% long term remission

  14. Antithyroid Medications • Propylthiouracil • Also blocks conversion of T4 to T3 • Preferred in pregnancy • Methimazole • Longer half life

  15. Antithyroid Medications • Side effects • Pruriticpapular or urticarial rash • Joint pain or stiffness • Hair loss • Nausea • Headache • Transient granulocytopenia

  16. Radioiodine Ablation • Oral iodine-131 • Concentrates in thyroid • Induces cell death • Cure rate >90%

  17. Radioiodine Ablation • Risks • 40-80% hypothyroidism • Children • Leukemia • Thyroid cancer • Genetic damage

  18. Subtotal orTotal Thyroidectomy • Patient population • Fail initial medical therapy • Relapse after cessation of medical therapy • Drug reactions • Large goiters • Severe ophthalmopathy

  19. Subtotal orTotal Thyroidectomy • Cure rate 90% • Risks • Complex surgical procedure • Hypoparathyroidism • Recurrent laryngeal nerve injury • Hypothyroidism

  20. Hyperthyroidism • Refer to pediatric endocrinologist • Underlying cause • Counseling on treatment options • Lifelong follow up is necessary

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