Hyperthyroidism | Diagnosis & Treatment

How is hyperthyroidism diagnosed?

Diagnosing hyperthyroidism starts with a complete medical history, followed by a physical exam. To confirm a diagnosis, your child’s doctor may:

  • request blood tests to check the levels of your child’s thyroid hormones and/or thyroid-stimulating antibodies (a test for Graves disease)
  • perform thyroid imaging studies, such as a thyroid scan or ultrasound, to determine the size, shape, function and position of the thyroid gland

How is hyperthyroidism treated?

Graves disease

Graves disease is the most common cause of hyperthyroidism in children and adolescents. The goal of treatment is to decrease the function of the thyroid gland back to normal so that it produces a normal amount of thyroid hormone.

There are three types of treatment for Graves disease:

  • Antithyroid drugs work by blocking the thyroid gland’s ability to make thyroid hormone. These drugs do not damage the thyroid gland itself. In many patients, antithyroid drugs can maintain normal thyroid hormone levels for many years. Some patients who respond well to antithyroid drugs may eventually be able to stop taking them and remain with normal thyroid function. Antithyroid drugs are generally safe but can have rare but serious side effects, so they need careful monitoring.
  • Radioactive iodine uses the thyroid gland’s natural need for iodine to treat overactive thyroid cells. Radioactive iodine is absorbed by and permanently destroys the thyroid gland, but does not affect other parts of the body. Once the thyroid gland is destroyed, the patient will need to take thyroid hormone medication.
  • Surgery to remove the thyroid gland is very effective for treating Graves disease. This procedure is generally safe but rarely can have serious complications. For this reason, it is important that the procedure be performed by an experienced thyroid surgeon. Lifelong thyroid hormone medication is needed after the thyroid is removed.

Additional treatments for Graves disease may include medications to improve symptoms (like palpitations and anxiety), which can be used temporarily until thyroid hormone levels are brought down to normal by one of the three treatments above.

Neonatal Graves disease

Neonatal Graves disease is a temporary condition that lasts only until the mother’s thyroid-stimulating antibodies have been cleared from the baby’s circulation. Until the condition goes away, antithyroid drugs are used to control the baby’s overactive thyroid. With prompt treatment, babies usually recover completely within a few weeks. However, either hyperthyroidism or hypothyroidism (low thyroid function) may occur later in the first year of life, so continued monitoring by a physician is important.

Autonomous thyroid nodules

Autonomous thyroid nodules are usually benign. Their treatment depends on how much thyroid hormone they produce, and on whether this is causing symptoms of thyroid hormone excess.

  • Autonomous nodules that are slightly overactive and cause no symptoms can often be observed without treatment.
  • Nodules that are very overactive or that cause symptoms can be treated with medication, surgery, or (in patients over 18 years) radioactive iodine ablation.

Our approach to treating autonomous nodules is slightly different than that recommended by the American Thyroid Association, which recommends surgery for all autonomous nodules in children. Our approach is based on our extensive experience with this condition—which was published after the release of the American Thyroid Association guidelines—showing that with careful evaluation, some autonomous nodules can be managed safely without surgery.

Thyroiditis

Hyperthyroidism caused by thyroiditis is usually temporary and goes away within 8-12 weeks. Because we cannot make this hyperthyroidism go away any faster, treatment focuses on medications to control any symptoms (like palpitations and anxiety) until the condition goes away on its own. Sometimes, this type of hyperthyroidism is followed by a period of hypothyroidism (low thyroid function), so continued monitoring by a physician is important.