RT Book, Section A1 Furtado, Nicholas A2 Schafermeyer, Robert A2 Tenenbein, Milton A2 Macias, Charles G. A2 Sharieff, Ghazala Q. A2 Yamamoto, Loren G. SR Print(0) ID 1105684199 T1 Thyroid Disorders T2 Strange and Schafermeyer's Pediatric Emergency Medicine, 4e YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-182926-7 LK accessemergencymedicine.mhmedical.com/content.aspx?aid=1105684199 RD 2024/11/11 AB The most common disorder causing thyrotoxicosis in children is Graves' disease.Thyroid hormones upregulate β-adrenergic receptors causing symptoms of sympathetic nervous system overactivity.Signs of sympathetic hyperactivity include tremor, brisk deep tendon reflexes, tachycardia, supraventricular tachycardia, flow murmur, overactive precordium, and a widened pulse pressure. Other cardiac disturbances such as atrial fibrillation and congestive heart failure (CHF) may also occur.Precipitating factors for thyroid storm in a patient with hyperthyroidism are thyroid surgery, withdrawal of antithyroid medications, radioiodine therapy, palpation of a goiter, iodinated contrast dyes, and stress.Thyroid storm is suggested by severe hyperpyrexia, atrial dysrhythmia, CHF, delirium or psychosis, severe gastrointestinal hyperactivity, and hepatic dysfunction with jaundice.Treatment consists of antithyroid drug propylthiouracil (PTU) at a dosage of 175 mg/m2/day or 4 to 6 mg/kg/day at 6- or 8-hour intervals, iodine therapy started 1 hour after antithyroid medication is initiated, β-adrenergic blockade with propranolol, 10 to 20 mg every 8 to 12 hours, and supportive management.