From the Guidelines
Adolescent hyperthyroidism should be treated with antithyroid medications, such as methimazole, as the first line of treatment, due to the high risk of complications and the significant impact on growth, development, and academic performance. The most common cause of hyperthyroidism in adolescents is Graves' disease, an autoimmune condition where antibodies stimulate the thyroid to produce excess hormones 1. Treatment typically begins with antithyroid medications such as methimazole (starting at 0.2-0.5 mg/kg/day, divided into doses) for 12-24 months. Propylthiouracil is generally avoided in adolescents due to liver toxicity risks. Beta-blockers like propranolol (10-40 mg every 6-8 hours) can help manage symptoms like tachycardia and tremors until thyroid levels normalize.
Some key points to consider in the management of adolescent hyperthyroidism include:
- Regular monitoring is essential, with thyroid function tests every 4-6 weeks initially, then every 2-3 months once stable 1.
- Adolescents should be monitored for medication side effects including rash, joint pain, and rarely agranulocytosis.
- The condition significantly impacts growth, development, and academic performance, so prompt treatment is crucial.
- School accommodations may be needed during active disease.
- Nutritional support is important as hyperthyroidism increases caloric needs and can lead to weight loss despite increased appetite.
- Family education about medication adherence and recognizing signs of thyroid storm (fever, severe tachycardia, altered mental status) is essential for successful management 1.
If medication fails or the condition relapses, definitive treatment with radioactive iodine (typically 10-15 mCi) or thyroidectomy may be considered. However, the decision to proceed with these treatments should be made on a case-by-case basis, taking into account the individual patient's circumstances and the potential risks and benefits of each treatment option.
From the FDA Drug Label
Pediatric Use Because of postmarketing reports of severe liver injury in pediatric patients treated with propylthiouracil, methimazole is the preferred choice when an antithyroid drug is required for a pediatric patient
Methimazole is the preferred choice for treating hyperthyroidism in pediatric patients, including adolescents, due to the risk of severe liver injury associated with propylthiouracil 2.
From the Research
Definition and Causes of Adolescent Hyperthyroidism
- Hyperthyroidism is a serious and rare disorder in childhood characterized by the overproduction of thyroid hormones by the thyroid gland 3.
- The leading cause of hyperthyroidism in adolescents is Graves' disease (GD), but other potential causes include toxic nodular goitre and other rare disorders leading to excessive production and release of thyroid hormones 4.
- Hyperthyroidism can be defined as overt or subclinical, with overt hyperthyroidism affecting approximately 0.2% to 1.4% of people worldwide and subclinical hyperthyroidism affecting approximately 0.7% to 1.4% of people worldwide 5.
Symptoms and Diagnosis of Adolescent Hyperthyroidism
- Typical symptoms of thyrotoxicosis include anxiety, insomnia, palpitations, unintentional weight loss, diarrhea, and heat intolerance 5.
- Patients with Graves' disease may have a diffusely enlarged thyroid gland, stare, or exophthalmos on examination 5.
- Diagnosis is apparent based on clinical presentation and initial biochemical evaluation, with additional diagnostic testing including measurement of thyroid-stimulating hormone receptor (TSHR) antibodies, analysis of thyroidal echogenicity and blood flow on ultrasonography, or determination of radioactive iodine uptake (RAIU) 4.
Treatment of Adolescent Hyperthyroidism
- Antithyroid drugs are the recommended first-line treatment to diminish hormone production, with alternative treatments such as radioactive iodine or thyroidectomy considered in cases of adverse effects to drugs, relapse, or non-remission of the disease 3.
- Treatment options for overt hyperthyroidism include antithyroid drugs, radioactive iodine ablation, and surgery, with treatment choices individualized and patient-centered 5.
- For subclinical hyperthyroidism, treatment is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L 5.
- In children, antithyroid drugs are recommended as the initial treatment, but alternative treatments such as radioactive iodine or thyroidectomy are considered in cases of relapse, lack of compliance, or antithyroid drug toxicity 6.