The Child With Graves Disease

Abstract

Hyperthyroidism is a rare but serious disease in children (Leger & Carel, 2013; Namwongprom, Unachak, Dejkamron, Ua-apisitwong, & Ekmahachai, 2013), characterized by overactivity of the thyroid gland that leads to elevation in circulating total and free thyroxine (T4) and tri-iodothyronine (T3) hormone levels, as well as metabolic acceleration in peripheraltissues.Physicalmanifestationsincludeacceleration of metabolic systems with symptoms such as thyroid goiter, feeling of fullness inthe throat, and difficulty swallowing. The child may exhibit irritability, anxiety, restlessness, or fatigue with inability to sleep. Increased appetite with weight loss and diarrhea may be present. The child has warm skin and heat intolerance. Academic performance may decline. Untreated hyperthyroidism has a negative metabolic effect on all body systems with tachycardia, hypertension, fever, and altered mental status and can lead to death (Bahn et al., 2011). Causes Hyperthyroidism is most commonly caused by Graves disease (GD), with a yearly incidence of approximately 1 per 100,000 (Breuer, Tuggle, Solomon, & Sosa, 2013). Other causes include McCune–Albright syndrome, a rare genetic condition (Tessaris et al., 2012), and neonatal hyperthyroidism caused by transfer of maternal thyroid antibodies across the placenta (Leger & Carel, 2013). This review is limited to a discussion of GD. GD is a benign, autoimmune thyroid condition resulting from thyrotropin (TSH) receptor stimulation by autoantibodies, is more common in females, and occurs most often in adolescence. Children who have other autoimmune diseases and those with family history of autoimmune disease are at a higher risk. While the exact cause is unknown, there is an interaction among genetic predisposition, environmental factors, and the immune system (Leger & Carel, 2013). Production of TSH-receptor antibodies stimulates the thyroid gland to produce excess thyroid hormone and has metabolic effects on every body and organ system. Children with GD have exophthalmos (protruding eyes), in addition to other signs and symptoms of hyperthyroidism.