Approach to a child with thyrotoxicosis
DOI:
https://doi.org/10.13112/pc.1234Keywords:
Thyrotoxicosis; Graves Disease; Hashimoto Disease; Antithyroid Agents; Thyroidectomy; Iodine RadioisotopesAbstract
Thyrotoxicosis is a clinical condition that occurs solely as a result of elevated serum concentrations of thyroid hormones. Hyperthyroidism is defined as a condition of elevated serum concentrations of thyroid hormones due to increased function, increased production, and secretion of the hormones triiodothyronine (T3) and thyroxine (T4). Any hyperthyroidism also means thyrotoxicosis, while not all thyrotoxicosis is a consequence of hyperthyroidism.
Thyrotoxicosis is caused by different etiologic factors and is manifested by various clinical signs of hypermetabolism. An appropriate therapeutic approach demands prompt and correct diagnosis and depends on the cause and condition of the patient. This article presents a clinical review of thyrotoxicosis treatment based on clinically acquired data. We searched the literature on PubMed and other published materials. Clinical description includes initial evaluation and approach to thyrotoxicosis; subclinical hyperthyroidism/thyrotoxicosis; Hashimoto’s and Graves’ disease, and approach to Graves’ hyperthyroidism, including antithyroid drugs, radioactive iodine, and surgical treatment.
Many recommendations and conclusions have been drawn on the basis of clinical data on the rational, safe, and optimal medical approach to patients with thyrotoxicosis. Choosing treatment for Graves’ disease is a complex process. Discussing the advantages and risks of recommended therapies with patients and parents is desirable. It is necessary to encourage parents of Graves’ disease patients with a minor chance of remission to make a quick decision on definitive care.
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