Clinical_Rounds_in_Endocrinology_Volume_II_-_Pediatric_Endocrinology

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62. How to evaluate children with hyperthyroidism?

The most common cause of hyperthyroidism in children is Graves’ disease.

Other rare causes include McCune–Albright syndrome and TSH receptor-

activating mutations. A careful examination for clinical features of McCune–

Albright syndrome (cafe-au-lait macules, bony swellings, signs of sexual

precocity, acro-gigantism) should be performed. Family history should be

obtained, as TSH receptor-activating mutation is an autosomal dominant dis-

order. In the absence of these clinical clues, further investigation is not war-

ranted and child should be managed as Graves’ disease (Figs. 3.20 and 3.21 ).

Fig. 3.19 A 15-year-old
boy with Graves’ disease
who has diffuse goiter and
thyroid-associated
orbitopathy

a bb

Fig. 3.20 A 14-year-old girl with Graves’ disease who had ( a ) diffuse goiter and asymmetrical propto-
sis ( b ) CT orbit showing thickening of extraocular muscles suggestive of thyroid-associated ophthal-
mopathy. Note the width of extraocular muscles ( arrow ) exceed the width of optic nerve ( arrow head )

3 Thyroid Disorders in Children