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60. What are the differences in clinical manifestation of hyperthyroidism in chil-
    dren as compared to adults?
    Most of the manifestations of childhood hyperthyroidism are similar to those
    seen in adults. However, there are some important differences between the two,
    which are summarized in the table given below.

Parameters Hyperthyroidism in children Hyperthyroidism in adults

Etiology Graves’ disease Graves’ disease

McCune–Albright syndrome,

TSH receptor-activating

mutations

Toxic multinodular goiter

Rarely, resistance to thyroid

hormone

Toxic adenoma

Growth acceleration Common –

Weight Weight loss uncommon,

weight gain can occur

Weight loss common

Atrial fi brillation Rare Common

Congestive heart failure Rare Common

Nervousness, hyperactivity Common Less common

Thyroid-associated

ophthalmopathy

Rare Common

Infi ltrative dermopathy/

acropachy

Rare Less common

61. What are the monosymptomatic presentations of childhood hyperthyroidism?

The monosymptomatic presentations of childhood hyperthyroidism include

accelerated growth velocity, poor scholastic performance and attention defi cit

hyperkinetic disorder, and diffuse goiter. In addition, children with thyrotoxico-

sis can rarely present with headache due to benign intracranial hypertension

and polydypsia (Fig. 3.19 ).

3 Thyroid Disorders in Children