RT Book, Section
A1 Furtado, Nicholas
A2 Schafermeyer, Robert
A2 Tenenbein, Milton
A2 Macias, Charles G.
A2 Sharieff, Ghazala Q.
A2 Yamamoto, Loren G.
SR Print(0)
ID 1105684199
T1 Thyroid Disorders
T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 4e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-182926-7
LK accesspediatrics.mhmedical.com/content.aspx?aid=1105684199
RD 2024/04/19
AB The  most  common  disorder  causing  thyrotoxicosis  in  children  is  Graves'  disease.Thyroid  hormones  upregulate  β-adrenergic  receptors  causing  symptoms  of  sympathetic  nervous  system  overactivity.Signs  of  sympathetic  hyperactivity  include  tremor,  brisk  deep  tendon  reflexes,  tachycardia,  supraventricular  tachycardia,  flow  murmur,  overactive  precordium,  and  a  widened  pulse  pressure.  Other  cardiac  disturbances  such  as  atrial  fibrillation  and  congestive  heart  failure  (CHF)  may  also  occur.Precipitating  factors  for  thyroid  storm  in  a  patient  with  hyperthyroidism  are  thyroid  surgery,  withdrawal  of  antithyroid  medications,  radioiodine  therapy,  palpation  of  a  goiter,  iodinated  contrast  dyes,  and  stress.Thyroid  storm  is  suggested  by  severe  hyperpyrexia,  atrial  dysrhythmia,  CHF,  delirium  or  psychosis,  severe  gastrointestinal  hyperactivity,  and  hepatic  dysfunction  with  jaundice.Treatment  consists  of  antithyroid  drug  propylthiouracil  (PTU)  at  a  dosage  of  175  mg/m2/day  or  4  to  6  mg/kg/day  at  6-  or  8-hour  intervals,  iodine  therapy  started  1  hour  after  antithyroid  medication  is  initiated,  β-adrenergic  blockade  with  propranolol,  10  to  20  mg  every  8  to  12  hours,  and  supportive  management.