Thyroid emergencies

10.3 Thyroid emergencies



Malcolm Higgins




Essentials



1. Life-threatening paediatric thyroid emergencies are rare.

2. Children with undiagnosed thyrotoxicosis or hypothyroidism may present to the ED with a range of acute symptoms and signs.

3. The identification, appropriate management and referral of children with congenital hypothyroidism is important as this condition may cause severe neurological impairment if untreated.

4. The onset of clinical hypothyroidism in Hashimoto’s thyroiditis may occur in adolescents.


Thyrotoxicosis


Hyperthyroidism is generally a disease of adult women but occasionally may present in adolescents. Although there are a number of causes the most common is Graves’ disease, which is thought to have an autoimmune basis. In approximately 1–2% of cases the presentation of hyperthyroidism is acute and severe. This has been called the ‘thyroid storm’ and is potentially life threatening. Other causes of hyperthyroidism in children include thyroiditis, iodine-induced hyperthyroidism, thyroid-stimulating hormone (TSH) hypersecretion, excessive ingestion of thyroid hormone and thyroid neoplasms. Hyperthyroidism is one of several endocrinopathies associated with McCune–Albright syndrome.



Clinical features


Raised levels of circulating thyroid hormone have predictable clinical effects depending on the organ system and are similar to the symptoms and signs of catecholamine excess (see Table 10.3.1). The onset of symptoms in Graves’ disease is usually insidious and variable in severity between patients. Severe ophthalmopathy or dermopathy is rare in children. Most patients with Grave’s disease will have a goitre characterized by diffuse, non-tender and symmetrical enlargement of the thyroid gland.












Table 10.3.1 Signs and symptoms of thyrotoxicosis
Symptoms

• Nervousness/irritability

• Heat intolerance and increased sweating

• Weight loss

• Behaviour problems and poor school performance

• Fatigue

• Restless sleep/insomnia

• Palpitations

• Diarrhoea

• Menstrual irregularities
Signs

• Tachycardia, hypertension

• Thyroid enlargement with bruit or thrill

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Sep 7, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Thyroid emergencies

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