Thyrotoxicosis is relatively rare in children. Typical symptoms include weight loss, irritability, tachycardia (which may be experienced as palpitations), sweating and heat intolerance. Attention span and school performance can be affected due to the cognitive and psychosocial impact of excess thyroid hormones. More longstanding hyperthyroidism can also lead to growth acceleration and osteopenia, secondary to suboptimal bone mineralisation. Most cases of hyperthyroidism in childhood are due to autoimmune Graves disease.
Who to refer:
- If the child has tachycardia, hypertension, tremor and/or palpitations present, referral via acute paediatrics on the same day may be indicated, even before blood results are available.
- If biochemical hyperthyroidism is confirmed, referral should be made to paediatric endocrinology. Raised T3/T4 in the presence of suppressed TSH is highly suggestive of hyperthyroidism.
- Clinical assessment should include: BP, HR, presence and size of goitre, presence of eye signs.
- If bloods are being repeated prior to referral, for example to confirm abnormal results, please request thyroid receptor antibodies (TRABs).
Who not to refer:
Children who have symptoms suggestive of hyperthyroidism, but normal biochemistry, will not generally be accepted as referrals to paediatric endocrinology and should have other potential causes explored.
How to refer:
- Children and young people with evidence of thyrotoxicosis should be referred urgently (same day) to paediatric endocrinology.
This can be done via the team registrar on bleep 9187 (Mon-Fri 9-5pm), and outwith normal working hours, please refer via the senior medical paediatric registrar on bleep 9424.
- For children and young people with mild biochemical derangement, or well children with confusing thyroid function tests results, please refer via SCI Gateway to RHCYP – Endocrinology. The responsible consultant will either respond with advice or appoint the child to an out-patient clinic.
