Hyperthyroidism, also known as thyrotoxicosis, is a condition caused by excessive thyroid hormone in the bloodstream. It is relatively rare in children, especially those under 3 years old, and occurs more frequently in girls. In children, the primary cause is toxic diffuse goiter (Graves' disease). The exact pathogenesis remains unclear but is believed to involve autoimmune mechanisms. The condition has a familial predisposition and may be triggered by factors such as infections, psychological trauma, or emotional stress. Besides Graves' disease, hyperthyroidism can also result from thyroiditis, pituitary TSH-secreting tumors, among other causes. Additionally, newborns of mothers with hyperthyroidism may experience transient neonatal hyperthyroidism.

bubble_chart Clinical Manifestations

The main symptoms include increased metabolism, goiter, and exophthalmos. The child exhibits excessive appetite, weight loss, heat intolerance, profuse sweating, irritability, excitement, emotional instability, and hand tremors. The heart rate is increased (remaining elevated even at rest and during sleep), and the pulse pressure widens. Diarrhea and weakness are also present. A diffuse enlargement of the thyroid gland in the front of the neck can be palpated with a tremor, and auscultation reveals vascular murmurs. Half of the cases are accompanied by unilateral or bilateral exophthalmos.

bubble_chart Auxiliary Examination

1. Serum T3 and T4 levels are elevated, with T3 being particularly prominent. γT3 shows significant elevation early on.
2. Thyroid ¹³¹I uptake test: The uptake rate is increased, and the peak occurs earlier.
3. Thyroid suppression test: This condition is not suppressed. This method is not used for patients with heart disease.
4. Serum TSH is normal.
5. Elevated levels of anti-thyroglobulin antibodies and anti-thyroid microsomal antibodies in the blood.
6. Basal metabolic rate is increased, generally ranging between 15-30%, and even higher in severe cases.
7. Other findings include low blood cholesterol, and bone age may exceed the normal range.

bubble_chart Treatment Measures

1. General treatment: Avoid emotional fluctuations, ensure adequate rest, and maintain a diet with sufficient calories and rich vitamins.
2. Antithyroid drugs: Start with methimazole at 0.4–0.6 mg/(kg•d), or methylthiouracil (5–7 mg/(kg•d)), or propylthiouracil, administered orally in three divided doses to control symptoms. Continue for 4–8 weeks, then reduce to 1/3 or 1/2 of the initial dose for maintenance therapy lasting 2–3 years. During treatment, regularly monitor T3, T4, and TSH levels, and watch for side effects (leukopenia, drug rash, liver injury).
3. Thyroid hormone: If thyroid enlargement or hypothyroidism symptoms appear after symptom control with the above drugs, add thyroid tablets at 30–60 mg.
4. Symptomatic treatment: For tachycardia, use propranolol at 1–2 mg/(kg•d), divided into three oral doses (avoid in cases of heart failure, asthma, or heart block). Sedatives may be used if necessary, such as phenobarbital at 2–3 mg/(kg•d) or diazepam at 0.25–0.5 mg/(kg•d). For exophthalmos, use prednisone at 1–2 mg/(kg•d) and vitamin B6.
5. Neonatal hyperthyroidism: Use compound iodine solution, 1 drop three times daily, and methimazole at 0.5–1.0 mg/(kg•d). Sedatives and Rehmannia may be used if needed.
6. Treatment of thyroid storm: Hyperthyroid children may experience a crisis under stress (e.g., infection, trauma, surgery), presenting with high fever, dysphoria, vomiting, diarrhea, tachycardia, profuse sweating, and even shock in severe cases. Treatment includes: (1) Antithyroid drugs, with the first dose at half the full amount; (2) Compound iodine solution, 1–5 drops every 6–8 hours; (3) Propranolol, 1–2 mg/kg daily, every 6–8 hours; (4) Hydrocortisone, 5–10 mg/kg daily, diluted and administered intravenously; (5) Control of precipitating factors; (6) Symptomatic treatment, such as sedation, fever reduction, and shock management.
7. Surgical treatment: Consider surgery if the enlarged gland compresses the trachea and affects breathing, if there is severe allergy to antithyroid drugs, or if long-term medication is ineffective with recurrent episodes. Preoperatively, medical therapy should first normalize thyroid function.

AD

TCM can effectively treat dry eye syndrome, floaters, retinopathy, and various chronic eye diseases

bubble_chart Differentiation

1. For patients with goiter, differentiation should be made from simple goiter and goitrous hypothyroidism, as the latter two do not present with hyperthyroidism.
2. For patients with exophthalmos, differentiation should be made from hematologic diseases (chloroma, xanthoma) and intraorbital tumors.