Thyrotoxicosis

This is most commonly caused by Grave’s disease. Neonatal Grave's occurs due to placental passage of maternal anti-thyroid antibodies.

Presentation

• Weight loss

• Restlessness

• Excessive sweating

• Diarrhoea, Frequent changing of nappies

• Poor sleep

• Tachycardia

• Enlarged, smooth, firm, non-tender thyroid

• In older children, they may present similarly to ADHD

  • Hyperthyroidism should be part of investigations in any child who’s presentation suggests ADHD

Management

1st line - Carbimazole, Methimazole

• Important side-effect is hypothyroidism if dose is too high

Other options include:

• Radioactive Iodine – Usually delayed until adolescence

• Surgery - complications of this include:

  • Hypoparathyroidism (hypocalcaemia)

  • Recurrent laryngeal nerve damage (vocal cord paralysis, hoarse voice)