Pediatric Hyperthyroidism Differential Diagnoses

  • Author: Robert J Ferry Jr, MD; Chief Editor: Stephen Kemp, MD, PhD   more...
 
Updated: Nov 3, 2011
 
 

Diagnostic Considerations

Onset of hyperthyroidism symptoms can be gradual, and patients are often referred for psychiatric or neurologic evaluation before the correct diagnosis is made.

Failure to diagnose hyperthyroidism, particularly in patients with psychiatric disorders, can have serious consequences for both the patients and individuals in their communities.

Thyroid storm is a life-threatening condition characterized by fever, altered mental status, and exaggerated signs and symptoms of hyperthyroidism. It is quite rare in children, especially since the advent of pretreatment for surgery and radiotherapy. Because no specific laboratory findings define this condition, any suspicion that a patient has thyroid storm should result in immediate referral to a pediatric intensive care unit and consultation with a pediatric endocrinologist.

Trauma to the neck area in a patient with Graves disease could precipitate thyroid storm.

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Robert J Ferry Jr, MD  Professor and Chief, Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Tennessee Health Science Center; Brigade Surgeon, 36th Sustainment Brigade, US Army; Adjunct Professor, Pediatric Surgery Department, King Saud University, Saudi Arabia

Robert J Ferry Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, and Texas Pediatric Society

Disclosure: Nutropin Speakers Bureau Honoraria Speaking and teaching; Genotropin Speakers Bureau Honoraria Speaking and teaching; Eli Lilly & Co. Grant/research funds Investigator; MacroGenics, Inc. Grant/research funds Investigator; Ipsen, S.A. (formerly Tercica, Inc.) Grant/research funds Investigator; NovoNordisk SA Grant/research funds Investigator; Diamyd Investigator

Coauthor(s)

Jonathan G Gold, MD  Associate Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University College of Human Medicine

Jonathan G Gold, MD is a member of the following medical societies: American Academy of Pediatrics and Council on Medical Student Education in Pediatrics

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD  Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, and Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Endocrinology, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Cydney L Fenton, MD, FAAP Consulting Staff, Department of Pediatric Endocrinology, Children's Hospital Medical Center of Akron

Cydney L Fenton, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Ab Sadeghi-Nejad, MD Chief, Division of Pediatric Endocrinology and Metabolism, Tufts Medical Center; Professor of Pediatrics, Tufts University School of Medicine

Ab Sadeghi-Nejad, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Advancement of Science, American Pediatric Society, Endocrine Society, Massachusetts Medical Society, Pediatric Endocrine Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Thomas A Wilson, MD Professor of Clinical Pediatrics, Chief and Program Director, Division of Pediatric Endocrinology, Department of Pediatrics, The School of Medicine at Stony Brook University Medical Center

Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Pediatric Endocrine Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Emiliano AB, Governale L, Parks M, Cooper DS. Shifts in Propylthiouracil and Methimazole Prescribing Practices: Antithyroid Drug Use in the United States from 1991 to 2008. J Clin Endocrinol Metab. Mar 24 2010;[Medline].

  2. Bartalena L, Baldeschi L, Dickinson AJ, et al. Consensus statement of the European group on Graves' orbitopathy (EUGOGO) on management of Graves' orbitopathy. Thyroid. 2008;18:333-46. [Medline].

  3. Bahn R. The EUGOGO consensus statement on the management of Graves' orbitopathy: equally applicable to North American clinicians and patients. Thyroid. 2008;18:281-2. [Medline].

  4. Yoshimura Noh J, Miyazaki N, et al. Evaluation of a new rapid and fully automated electrochemiluminescence immunoassay for thyrotropin receptor autoantibodies. Thyroid. 2008;18:1157-64. [Medline].

  5. [Guideline] US Preventative Services Task Force. Screening for thyroid disease: recommendation statement. Ann Intern Med. Jan 20 2004;140(2):125-7. [Medline].

  6. FDA MedWatch Safety Alerts for Human Medical Products. Propylthiouracil (PTU). Accessed: June 3, 2009. US Food and Drug Administration; [Full Text].

  7. Sisson JC, Freitas J, McDougall IR, et al. Radiation safety in the treatment of patients with thyroid diseases by radioiodine 131I : practice recommendations of the American Thyroid Association. Thyroid. Apr 2011;21(4):335-46. [Medline].

  8. [Guideline] Bahn Chair RS, Burch HB, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. Jun 2011;21(6):593-646. [Medline].

  9. [Guideline] Kahaly GJ, Bartalena L, Hegedüs L. The American Thyroid Association/American Association of Clinical Endocrinologists guidelines for hyperthyroidism and other causes of thyrotoxicosis: a European perspective. Thyroid. Jun 2011;21(6):585-91. [Medline].

 
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Schematic representation of the negative/positive feedback system with respect to the hypothalamic-pituitary-thyroid axis. TRH = thyrotropin-releasing hormone; TSH = thyroid-stimulating hormone.
 
 
 
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