On the basis of strong research evidence,
hyperthyroidism is a rare but potentially serious disorder in childhood that, if uncontrolled, can lead to a wide range of complications, including effects on growth and development. • On the basis of strong research evidence,
Graves' disease is the most common cause of
hyperthyroidism in children, accounting for greater than 95% of cases. It is caused by stimulating
antibodies to the
thyroid-stimulating hormone receptor. • On the basis of some research evidence and consensus, history, physical examination, and thyroid function tests help diagnose
hyperthyroidism. The condition is characterized by suppressed serum
thyrotropin and elevated serum
triiodothyronine and
thyroxine. Radioactive
iodine (or technetium-99) uptake and serum thyroid antibody measurements help determine the cause of
hyperthyroidism. • On the basis of some research evidence and consensus, treatment options for
Graves' disease in children include antithyroid medications, radioactive
iodine, and surgery. Antithyroid medications are commonly used as the first-line
therapy in children. However, because of the low rates of spontaneous remission, most children eventually require permanent treatment with radioactive
iodine or surgery. Of the available antithyroid medications, current guidelines recommend use of
methimazole and not
propylthiouracil because of the unacceptable risk of hepatotoxicity associated with
propylthiouracil. • On the basis of strong research evidence,
thyroid storm is a rare life-threatening endocrine emergency that should be suspected in children with
hyperthyroidism who demonstrate evidence of systemic decompensation. • On the basis of strong research evidence, neonatal
hyperthyroidism can occur in infants born to mothers with a history of
Graves' disease due to transplacental passage of
TSH receptor stimulating
antibodies.