Hyperthyroidism (Graves Disease):

Graves diseases is  the most common cause of hyperthyroidism  in  children and is usually associated with an  enlarged thyroid gland and exophthalmus. The peak  incidence of the disease occurs between 12 and  14  years of age,  but  it may  be present at birth  in  children of thyrotoxic mothers, The  incidence is five times higher  in  girls than  in  boys. There is no specific cause of this disease but it  is apparently caused by  a serum  thyroid stimulating immunoglobulin and has familial association; a  large number of  persons with  the diseAse possess the histocompatibility  antigenc (HLA-B8). The child presents the signs and symptoms such as; emotional liability, restlessness, low school performance, fatigue, tachycardia, dyspnea on exertion, exophthalmos tremor, goiter, warm moist skin, heat  intolerance, systolic murmur, thyroid storm such as severe irritability, anorexia and weightloss vomiting, diarrhoea,  hyperthyroidism, hypertension, severe tachycardia, prostration. This may  lead  to delirium coma and  death. Therapeutic management consists of anti  thyroid drugs, subtotal thyroidectomy and ablation with  radio iodine (131 - lodide). The children should be advised to restrict vigorous exersion  until1 thyroid levels are decreased  to normal.