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Hyperthyroidism I: Introduction01:25

Hyperthyroidism I: Introduction

30
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
30
Hyperthyroidism II: Pathophysiology01:27

Hyperthyroidism II: Pathophysiology

28
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH...
28
Graves Disease II: Pathophysiology01:24

Graves Disease II: Pathophysiology

26
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor,...
26
Graves' Disease I: Introduction01:28

Graves' Disease I: Introduction

23
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence...
23
Goiter01:27

Goiter

32
Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...
32
Functions of Thyroid Hormones01:18

Functions of Thyroid Hormones

5.8K
The thyroid hormone (TH) plays a pivotal role in the intricate orchestration of physiological processes, exerting profound effects on development, metabolism, and homeostasis throughout different life stages.
TH is indispensable for the normal development and maturation of the skeletal, muscular, and nervous systems during fetal and childhood growth. It facilitates bone mineral turnover and regulates protein synthesis in developing tissues, contributing significantly to overall growth and...
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Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
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QT prolongation in a child with thyroid storm.

Benjamin B Albert1, Luke Gerard Eckersley, Jonathan Robert Skinner

  • 1Liggins Institute, University of Auckland, Auckland, New Zealand.

BMJ Case Reports
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Summary

Severe hyperthyroidism in a child caused QTc prolongation, a heart rhythm issue. Treatment normalized thyroid function and the QTc interval, highlighting the need for cardiac monitoring in pediatric hyperthyroidism.

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Area of Science:

  • Pediatric Endocrinology
  • Cardiology
  • Internal Medicine

Background:

  • Hyperthyroidism, a condition of overactive thyroid, can manifest with various systemic effects.
  • QTc prolongation, an indicator of prolonged ventricular repolarization on electrocardiogram (ECG), is a known risk factor for arrhythmias.
  • The association between hyperthyroidism and QTc prolongation in pediatric populations is not widely recognized.

Observation:

  • A 12-year-old girl presented with symptoms of severe hyperthyroidism, including an acute confusional state, weight loss, anxiety, agitation, and recurrent fever.
  • Thyroid function tests confirmed severe hyperthyroidism, leading to a diagnosis of thyroid storm (Burch and Wartofsky score=75).
  • Electrocardiogram (ECG) revealed a significantly prolonged QTc interval (506 ms).

Findings:

  • The patient received acute treatment for thyroid storm, including Lugol's iodine, prednisolone, carbimazole, and propranolol.
  • Following treatment, the patient experienced a steady recovery, with normalized thyroid function and QTc interval (430 ms) by 3 months.
  • This case demonstrates a direct correlation between hyperthyroidism and QTc prolongation, with resolution upon achieving euthyroidism.

Implications:

  • This case highlights a potentially under-recognized complication of hyperthyroidism in children: QTc prolongation.
  • Routine QTc interval measurement should be considered as part of the management protocol for pediatric hyperthyroidism.
  • Early identification and management of QTc prolongation in pediatric hyperthyroidism may help prevent serious cardiac events.