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Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents

Stephen LaFranchi, MD
Section Editor
Mitchell E Geffner, MD
Deputy Editor
Alison G Hoppin, MD


The clinical manifestations of hyperthyroidism in children and adolescents are similar to those seen in adults. In addition, the disorder has unique effects on growth and development. The clinical features of hyperthyroidism are largely independent of the cause. While the terms hyperthyroidism and thyrotoxicosis are often used interchangeably, in this topic thyrotoxicosis refers to the clinical symptomatology resulting from excess thyroid hormone, either of endogenous or exogenous origin. Hyperthyroidism refers specifically to excessive synthesis and secretion of endogenous thyroid hormone. Although there are several potential causes of hyperthyroidism in children, Graves' disease is by far the most common etiology.

In addition to causing hyperthyroidism, Graves' disease causes unique problems that are not related to the high serum thyroid hormone concentrations. They include Graves' ophthalmopathy and infiltrative dermopathy (localized or pretibial myxedema). Graves' ophthalmopathy is common in children, but less severe than in adults; dermopathy is almost never found in children. Most patients with Graves' hyperthyroidism have a diffuse goiter, but so do patients with other, less common causes of hyperthyroidism, such as "Hashitoxicosis" (silent or painless thyroiditis), subacute thyroiditis, or forms of nonautoimmune hyperthyroidism. These disorders are discussed briefly in this topic review. (See 'Destructive thyroiditis' below.)

The clinical presentation and laboratory evaluation of children with hyperthyroidism and thyrotoxicosis are discussed here. Treatment of hyperthyroidism is discussed separately. Hyperthyroidism presenting during the neonatal period also is discussed separately. (See "Treatment and prognosis of Graves' disease in children and adolescents" and "Evaluation and management of neonatal Graves' disease".)


Graves' disease is by far the most common cause of hyperthyroidism in children and adolescents. In a national population-based study of thyrotoxicosis from the United Kingdom and Ireland in 2004, the annual incidence was 0.9 per 100,000 children <15 years of age, with Graves' disease accounting for 96 percent of cases [1]. A nationwide study from Denmark reported an incidence of 0.79 per 100,000 in children <15 years of age in the time period of 1982 to 1988, with a doubling to 1.58 per 100,000 in the years 1998 to 2012 [2]. A report using data from the US National Health and Nutritional Examination Surveys (NHANES) analyzing adolescents and young adults found that thyrotoxicosis was more common in non-Hispanic blacks than Mexican-Americans, in whom it was more common than non-Hispanic whites [3]. Overall, the prevalence of Graves' hyperthyroidism in children is approximately 0.02 percent (1:5000), mostly in the 11- to 15-year age group [4]. In a report of 143 children with Graves' disease, 38 percent were prepubertal at diagnosis [5]. Girls are affected more commonly than boys, at a ratio of about 5:1. The ratio is considerably lower among younger children, suggesting that estrogen secretion in some way affects the occurrence of Graves' disease.


The proximate cause of Graves' hyperthyroidism in children and adolescents, as in adults, is thyrotropin (TSH) receptor-stimulating antibodies (TSHR-Ab), which activate the TSH receptor. A population-based study of Danish twins suggested that approximately 80 percent of the risk of Graves' disease is attributable to genetic factors [6] (see "Pathogenesis of Graves' disease"). The development of Graves’ disease has also been reported in children after hematopoietic stem cell transplantation, so-called Graves’ immune reconstitution inflammatory syndrome (IRIS) [7]. The mechanism is believed to be immunological dysregulation during T-cell engraftment with subsequent production of TSHR-Ab by B-cells.

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Literature review current through: Nov 2017. | This topic last updated: Oct 11, 2016.
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