Clinical case for a patient I had seen. The presentation focus on a small introduction for Thyroid Disease in children, Graves Disease pathophysiology, diagnosis and treatment.
2. Subjective
9 year old girl
• Fever > 38.5 grade and abdominal pain started 5 days ago
• Vomiting
• Palpitation (HR 114)
• Diarrhea
• Hematuria
Medical history
• Tonsillectomy sep 2016
• Asthma (controlled)
• Graves disease Dec 2016 (uncontrolled)
Medication
• Carbimazole tabs 5mg
• Nexazole 20mg
• Singulair 5mg
3. Birth history
• Normal delivery, born 37 weeks
• Hyperemesis Gravidarum
• Birth weight 7.6 pound
Family history
• Grandmother with gravis disease
• Mother with hypothyroidism
• Sister with asthma
• Aunt with cystic fibrosis
Social history
• Mother smoke
• Like piano and swim
4. Objective
Vital sign
RR: 20 , Po2: 97 , HR: 95 , Temp: 36.5 , weight: 28.4 kg
Physical exam
Inspection: eye slightly bulging, goiter
Palpation: abdomen soft no tenderness
Auscultation: lung are clear and heart is normal
Further exam
Urine culture: non significant
Blood test:
14/12/2017: Free T3: 5.93 high, Free T4: 9.3 low , TSH: 0.03 low
28/12/2017 : Free T3: 4.79high , Free T4: 5.2 low, TSH: 1.19
6. Thyroid disease in children
Congenital Hypothyroidism
• Affect infants at birth
• 1 in 4000 live born babies
• Loos of thyroid function - absent
• Delayed treatment – growth and development defects
• Heelprick blood sample- assess thyroid hormone level.
Hyperthyroidism in newborns
• Thyroid stimulating antibodies cross the placenta –
produce too much thyroid hormone.
• No treatment maybe necessary – low antibodies
7. Hashimoto’s thyroiditis
• Most common of hypothyroidism in children
• Occur at any age – symptoms develop very slowly.
• Thyroid gland – underactive
• Laboratory diagnosis; T3, T4 decrease and TSH increase
8. graves disease
Most common form of hyperthyroidism in children.
Etiology:
• Excessive thyroid hormone production, caused by
thyrotropin receptor-stimulaing antibodies (TRS-Ab)
• Girls > boys
• Increase risk for other autoimmune disorders
General impression:
Stable, alert, eyes slightly bulging
Goiter
Physical exam:
Lung and heart; no abnormality
Abdomen is soft no tenderness
Further exam:
Urine culture non significant
It is an autoimmune condition that affects thyroid function, causing enlargement and over activity of thyroid
is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause.
Addison disease, insulin-dependent diabetes mellitus, celiac disease
SLE and pernicious anemia