Graves’s Disease/Hyperthyroidism

Hyperthyroidism is the condition that results when too much thyroid hormone is in the bloodstream. Thyroid hormone is produced in the thyroid gland, which is a small, butterfly-shaped gland that lies just under the Adam's apple in the neck. There are two lobes to the gland, and they lie just in front and at either side of the windpipe (trachea). The thyroid is part of the body's endocrine system, which consists of glands that secrete hormones into the bloodstream. Almost every cell in the body, from those in the brain to those in the feet, responds to these thyroid hormones. Because thyroid hormone has global effects on the body, there are a variety of symptoms associated with hyperthyroidism, including:

  • anxiety
  • heart palpitations (heart "racing")
  • sweating
  • weight loss for no apparent reason
  • diarrhea

Hyperthyroidism can be treated in different ways depending on why the thyroid is overactive and the age of the patient. The patient may be treated with some medications that decrease the production of thyroid hormone or by surgical removal of part of the thyroid gland.

The most common cause of hyperthyroidism in children is a condition is called Graves' disease. It is a condition in which the body produces abnormal cells (antibodies) that result in the thyroid gland's overproduction of thyroid hormone. The diagnosis is usually made after noticing the physical symptoms of hyperthyroidism, and confirming the suspicion with special blood tests specific for this disease. In children, it is usually treated with medications first. However, if medications are not effective, the thyroid gland may have to be destroyed with radioactive iodine. If that is not an option, surgical removal may be considered.

Thyroiditis - tenderness and inflammation of the thyroid gland – is another, less common, cause of thyroid over-function. While the thyroid is inflamed, excessive thyroid hormone can be released, resulting in hyperthyroidism. After the hyperthyroid stage resolves, there may also be a period of hypothyroidism. There are two types of thyroiditis:

  1. Acute Suppurative Thyroiditis: severe pain and swelling around the thyroid gland, along with fever. It is usually caused by a bacterial infection. Ultrasound can be used to look for abscesses (collections of pus). Treatment consists of antibiotics (usually given by a vein at the start of treatment), and possible surgical drainage or partial thyroid removal if an abscess is found.

  2. Subacute Thyroiditis: a less severe form of thyroiditis usually caused by a virus. It typically presents with a low-grade fever, mild pain and tenderness in the area of the thyroid gland, and minimal enlargement of the thyroid gland. This diagnosis is sometimes confused with Graves' disease, but a thyroid scan can differentiate the two. Subacute thyroiditis usually resolves without treatment although supportive measures (fluids, rest and pain medicine) may make the patient more comfortable.

Useful Links:

American Thyroid Association
(http://www.thyroid.org/)

Thyroid Federation International
(http://www.thyroid-fed.org/tfi/index.php?l=en-US#home)

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