Annotation
Treatment of hyperthyroidism in young people
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Introduction |
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Graves' disease is rare in childhood but occurs with increasing frequency into adolescence and young adult life. There is a strong familial predisposition but the precipitating cause is not known. Stimulation of the thyroid stimulating hormone (TSH) receptor by autoantibodies causes excessive thyroid hormone production and secretion, and diffuse enlargement of the thyroid. Other systems may be involved, notably the eyes with proptosis. In children the early symptoms of hyperthyroidism are non-specific and may be of gradual onset; unless there is an obvious goitre, a psychological or behavioural disorder is often suspected. Once considered, the diagnosis is readily confirmed biochemically by raised concentrations of circulating thyroid hormones and suppression of TSH.
The aim of treatment is to restore and maintain permanent euthyroidism
as safely, quickly, and conveniently as possible. Especially in young
people, there is no consensus on how this is best achieved and in this
annotation we shall consider
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