Causes of thyrotoxicosis in children and adolescents

Name	Synonyms	Mechanism	Antibody tests; thyroglobulin where indicated	RAI	Thyroid examination
Thyroid gland hyperfunction (increased synthesis of thyroid hormones)
Graves disease	Hyperthyroid goiter von Basedow disease	TSHR-Ab	TSHR-Ab* positive (TSI positive and TBII positive in typical cases) TPO-Ab positive or negative	High, diffuse	Symmetric nontender goiter
Multinodular hyperthyroid goiter	Toxic multinodular goiter	Autonomous overproduction of thyroid hormone by nodules	All negative	Normal or high, multifocal	Nodular
Autonomous nodule	Plummer disease Toxic nodule	Autonomous overproduction of thyroid hormone by a single nodule	All negative	High, single focus; rest of gland suppressed	Single nodule
TSH-producing pituitary adenoma		Autonomous overproduction of TSH	All negative	High, diffuse	Normal or symmetric goiter
Pituitary resistance to thyroid hormone		Overproduction of TSH	All negative	High, diffuse	Symmetric goiter
Thyrotoxic phase of thyroiditis (excess release of preformed thyroid hormones)
Thyrotoxic phase of autoimmune thyroiditis (Hashimoto disease)	Hashitoxicosis Lymphadenoid goiter	Autoimmune; release of preformed hormone	TPO-Ab positive Anti-thyroglobulin antibody positive TSHR-Ab* usually negative (TSI is usually negative; TBII may be positive)	Low in majority; inhomogeneous pattern	Firm goiter, sometimes tender
Subacute autoimmune thyroiditis	Painless sporadic thyroiditis Silent thyroiditis	Autoimmune; release of preformed hormone May also be associated with drugs (IFN-alpha, IL-2, checkpoint inhibitors, or lithium)	TPO-Ab positive	Low (during thyrotoxic phase)	Firm nontender, mildly enlarged thyroid
Subacute granulomatous thyroiditis	Subacute thyroiditis Painful subacute thyroiditis de Quervain thyroiditis Granulomatous giant cell thyroiditis	Viral infection; release of preformed hormone	TPO-Ab negative Elevated ESR	Low (during thyrotoxic phase)	Painful goiter
Drug-induced thyrotoxicosis
Factitious thyrotoxicosis	Thyrotoxicosis factitial	Ingestion of exogenous thyroid medication	Low serum thyroglobulin	Low or absent	No goiter
Iodine-induced hyperthyroidism		Underlying multinodular goiter; thyroid hormone release triggered by exposure to iodine (eg, contrast agents, amiodarone)		Usually decreased but may be normal or increased	Often multinodular

RAI: radioactive iodine uptake; TSHR-Ab: thyrotropin receptor-stimulating antibodies; TSI: thyroid-stimulating immunoglobulin; TBII: thyrotropin-binding inhibitor immunoglobulin; TPO-Ab: thyroid peroxidase antibodies; TSH: thyroid-stimulating hormone (thyrotropin); IFN-alpha: interferon alfa; IL-2: interleukin-2; ESR: erythrocyte sedimentation rate.
* TSHR-Ab can be measured by either a TSI or TBII. In many laboratories, this is now ordered as "TSH receptor antibody" test (TSHR-Ab, or simply TRAb). A positive TSI confirms the presence of a stimulating antibody and a diagnosis of Graves disease. A positive TBII (or TSHR-Ab) confirms that there is an antibody that competes with TSH binding to its receptor, but does not provide information about whether it is a stimulating or blocking antibody. A positive TBII (or TSHR-Ab) in a patient with clinical thyrotoxicosis is most likely indicative of Graves disease.

Graphic 58890 Version 15.0

خرید پکیج

Causes of thyrotoxicosis in children and adolescents