The evaluation and management of thyrotoxicosis

Abstract 

The commonest cause of thyrotoxicosis in childhood and adolescence is Graves’ disease, where autoantibodies stimulate the thyrotropin receptor and lead to excess thyroid hormone production. Excess thyroid hormone can have a deleterious effect on all body systems and so thyrotoxicosis should be considered in all young people with unexplained symptomatology. The diagnosis is confirmed by a combination of biochemical and immunological tests. Thyroid gland imaging may be useful in some circumstances. Treating Graves’ disease is difficult because of the chronic nature of the disorder and because the available options—anti-thyroid drugs, surgery and radio-iodine—all have significant disadvantages. Families need to be aware of the treatment options so that therapy can, where possible, be tailored to the individual.

This patient's eyes “… were protruded from their sockets, and the countenance exhibited an appearance of agitation and distress …” (Caleb Hillier Parry, 1786).

Keywords:  Thyrotoxicosis, Graves’ disease, Anti-thyroid drugs, Radio-iodine