A‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ student post this as a discussion, please reply with 1 ref
A‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ student post this as a discussion, please reply with 1 reference. Hyperthyroidism transpires in childhood, when the thyroid gland overproduces thyroid hormone or if a child is given a large dose of thyroid hormone replacement (Garzon Maaks, et al., 2020). The thyroid gland is a butterfly-shaped endocrine gland. The function of the thyroid gland is to release thyroid hormone into the blood controlling the body’s heart rate, temperature, and metabolism (Children's Hospital Colorado , 2021). Thyroid-stimulating immunoglobulins adhere to the thyroid-stimulating hormone (TSH) receptor in hyperthyroidism. Therefore, resulting in excessive thyroid hormone production (Garzon Maaks, et al., 2020). Once the thyroid gland releases an excess hormone, the child's metabolism speeds up, causing anxiety, weight loss, and tremors. In pediatric patients, the thyroid hormone aids in ensuring that growth and development occur customarily and that the body's metabolism, energy, heart, muscles, and other organs are working appropriately (American Thyroid Association, 2021). Causes of hyperthyroidism in pediatric patients: The leading cause of hyperthyroidism is Graves disease an autoimmune condition in which the body’s immune system has some confusion and attacks the thyroid gland (Children's Hospital Colorado , 2021). Antibodies cause the thyroid gland to release excess thyroid hormone- and they also attack the muscles behind the eyes, causing both eyes to bulge (exophthalmos) (Children's Hospital Colorado , 2021). Graves disease accounts for about 95 % of hyperthyroidism in children (American Thyroid Association, 2018). Neonatal Graves’ disease Increased intake of dietary iodine Too much thyroid hormone medication Thyroiditis Hyperthyroidism is more prevalent in adolescent patients than in the younger population and research indicated it is frequently seen more in females than males (Children's Hospital Colorado , 2021). Risk Factors: Family history of thyroid disease or nodules Family history of autoimmune diseases Trauma to the thyroid glands (Children's Hospital Colorado , 2021) Clinical findings: Palpitations Restlessness Increased appetite with weight loss Fatigue Muscle weakness Poor sleeping habits Decrease‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍d concentration Poor heat tolerance Anxiety & Irritability For females, light and sporadic menstrual cycles (Garzon Maaks, et al., 2020) Physical Exam Findings: Goiter Audible thyroid bruit Tachycardia Underweight for height Tremors Exophthalmos (estimated fifty percent of children with Graves’ disease has exophthalmos) Nodule in the thyroid (Garzon Maaks, et al., 2020) Diagnostic testing: Obtain a thorough medical history Physical Exam Review the symptoms TSH, T3, T4, & Free T4 (American Thyroid Association, 2021) Ensure that providers are also aware of all medications the patient is taking such as prescribed medications and vitamins. Imaging Study: Thyroid ultrasound Medications: Medical management with methimazole (Tapazole) is the first line of treatment for pediatric patients with Graves’ disease (Garzon Maaks, et al., 2020). Propylthiouracil (PTU) is another antithyroid medication option for children that are allergic to methimazole (Garzon Maaks, et al., 2020). Beta-blockers may be utilized to slow down the heart rate until labs are stabilized. Continually educate the parents and children about the side effects of any new medications. Follow-up plan: As the provider, patients with hyperthyroidism should have routine follow-up visits to check the child’s growth and development, thyroid hormone levels, and other symptoms the child may be experiencing. The patient should return to the clinic at least within one to three months and then every three to six months once the levels have been regulated (Children's Hospital Colorado , 2021). Referrals: Children diagnosed with hyperthyroidism; a referral should be made to an endocrinologist to discuss treatment options such as medications (antithyroid medications) vs. subtotal thyroidectomy, or radioiodine (Garzon Maaks, et al., 2020). Treatment is crucial because hyperthyroidism is known to cause cognitive delays in children under three years of age. Hyperthyroidism can be dangerous to newborns if not diagnosed shortly after birth (Children's Hospital Colorado , 2021). The treatment goal for hyperthyroidism is to decrease or eradicate signs and symptoms and permit the child to return to their pre-hyperthyroid state (American Thyroid Associ‌‍‍‍‌‍‍‌‌‍‍‍‌‍‍‍‍‌‍‍ation, 2018).

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