A Teenager With Fever Who Can’t Talk After Visiting Mexico

Colleen Mathis, MD; Kimberly Monroe, MD, MS

Disclosures

October 30, 2020

Discussion

The patient's screening thyroid studies revealed a thyroid-stimulating hormone (TSH) level < 0.01 mIU/L, free triiodothyronine (T3) level > 20 pg/mL, and total thyroxine (T4) level > 29 µg/dL. Upon repeat examination, she was found to have a mildly enlarged diffuse goiter, which was previously unrecognized.

Hyperthyroidism in children and adolescents is relatively rare, occurring in 0.1-3 per 100,000 children; 95% of these patients are diagnosed with Graves disease.[1,2] As seen in the patient in this case, Graves disease is more common among females, with a peak incidence at age 10-15 years.[1] Graves disease involves the infiltration of lymphocytes into the thyroid gland and production of stimulating autoantibodies to the TSH (thyrotropin) receptor. These thyroid-stimulating immunoglobulins (TSIs) mimic the action of TSH, causing uninhibited production and release of thyroid hormones. This results in increased T3 and T4 levels and suppression of TSH.[1,2,3]

Patients typically present with weight loss, frequent stools, fatigue, palpitations, dyspnea, anxiety, emotional lability, and warm, moist skin.[3] Signs and symptoms of hyperthyroidism are similar in children and adolescents to those in adults. However, a considerable delay in diagnosis often occurs in children, ranging from 5 months in pubertal children to 8 months in prepubertal children.[2] Often, behavioral disorders, including attention-deficit/hyperactivity disorder or anxiety, respiratory diseases (eg, exercise-induced asthma), or primary cardiac diseases, are considered rather than hyperthyroidism as the cause of the symptoms.

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....