The thyroid gland may be small, but its impact on a child’s body is enormous.
Located at the front of the neck, this butterfly-shaped gland produces hormones that regulate metabolism, i.e. the process by which the body uses energy.
When the thyroid becomes overactive, producing excessive hormones, the condition is known as hyperthyroidism.
In children and adolescents, hyperthyroidism is less common than in adults, but when it occurs, it can significantly affect growth and health, even causing acute life-threatening complications.
Sudden crisis
Aisha is a 13-year-old girl who was brought to the emergency department with palpitations and breathlessness.
Her parents reported that she had been increasingly restless over the past few months.
She complained of feeling “tremulous” and “hot all the time”, had difficulty sleeping, and seemed more irritable than usual.
Despite eating well – sometimes more than usual – Aisha had lost a noticeable amount of weight.
Her teachers had also mentioned that she was struggling to concentrate in class.
On the day of admission, Aisha’s symptoms had suddenly worsened.
She felt her heart racing uncontrollably, became breathless even while resting, and felt continually anxious and confused.
At the hospital, she was found to have a very high heart rate, fever and signs of heart failure.
Further evaluation and tests confirmed that Aisha had hyperthyroidism, secondary to Graves’ disease, and had developed a thyroid storm – a life-threatening escalation of her condition.
She was immediately treated with both oral and intravenous (IV) medications to control her thyroid hormone production, reduce the effects of the hormones on her body, and manage her symptoms.
With prompt and intensive care, Aisha gradually recovered and her thyroid hormones stabilised with a single oral anti-thyroid medication.
Overproduction of hormones
Hyperthyroidism occurs when the thyroid gland produces too much thyroxine (T4) and triiodothyronine (T3).
These hormones control how fast the body’s organs function.
In excess, they accelerate nearly every system in the body.
In children, hyperthyroidism may present with:
- Unexplained weight loss despite a good or increased appetite
- Rapid or irregular heartbeat (palpitations)
- Nervousness, irritability or mood swings
- Heat intolerance and excessive sweating
- Prominent bulging eyes (exophthalmos)
- Tremors (shaky hands)
- Difficulty sleeping
- Enlarged thyroid gland (goitre)
- Decline in school performance or attention
- Heavy or frequent menses.
The most common cause is Graves’ disease, an autoimmune condition where the body produces antibodies that mistakenly stimulate the thyroid gland to produce excessive hormones.
Rapid escalation
Aisha’s story highlights an important message: a thyroid storm does not occur out of nowhere.
It is a severe and sudden worsening of hyperthyroidism, and although rare in children, carries a high risk of complications if not treated promptly.
It can be triggered by infections, stress, trauma, surgery, or undiagnosed or poorly-controlled hyperthyroidism.
In a thyroid storm, the body is overwhelmed by extremely high levels of thyroid hormones, leading to a hypermetabolic crisis.
Symptoms escalate rapidly and may include:
- Very high fever
- Severe tachycardia (extremely fast heart rate)
- Shortness of breath
- Agitation, confusion or altered consciousness
- Vomiting or diarrhoea
- Heart failure in severe cases.
This condition is a medical emergency requiring urgent hospital care, often in an intensive care setting.
Recognising the warning signs
A thyroid storm is usually preceded by symptoms of hyperthyroidism that may be subtle, non-specific or mistaken for normal adolescent changes.
Parents and caregivers should watch for:
- Unexplained weight loss despite normal or increased appetite
- Noticeable increase in heart rate, or frequent complaints of a “racing heart” or palpitations
- Changes in mood, such as anxiety, irritability or emotional outbursts
- Declining academic performance or difficulty concentrating
- Excessive sweating or intolerance to heat
- Tremors or shaky hands
- Enlarged neck (goitre)
- Prominent bulging eyes.
In adolescents, these symptoms can sometimes be misattributed to stress, puberty or lifestyle changes.
However, when multiple symptoms occur together or persist, medical evaluation is essential.
A simple blood test is often sufficient to diagnose hyperthyroidism.
Immediate medical attention is required if a child with suspected or known hyperthyroidism develops:
- High fever
- Severe palpitations or chest discomfort
- Shortness of breath
- Confusion, drowsiness or unusual behaviour
- Persistent vomiting or inability to keep fluids down.
These could signal the onset of thyroid storm, where every minute counts.
A manageable condition
The good news is that hyperthyroidism, including Graves’ disease, is treatable.
Early diagnosis allows for effective control of thyroid hormone levels, which will prevent complications.
Treatment options include:
- Anti-thyroid medications to reduce hormone production – these are often needed for at least two years
- Beta-blockers to control initial acute symptoms such as rapid heart rate
- Definitive treatments such as radioactive iodine therapy or surgery in selected cases.
A thyroid storm, although serious, can be successfully managed with rapid recognition and aggressive treatment.
This typically involves a combination of medications, supportive care and addressing any underlying triggers such as infection.
Thyroid disorders in children are often overlooked because their symptoms can mimic common issues such as stress, behavioural changes or growth-related fluctuations.
However, as Aisha’s case illustrates, untreated hyperthyroidism can escalate into a life-threatening emergency.
Awareness is key.
By recognising early signs and seeking timely medical care like a paediatric endocrine consult, parents and healthcare providers can prevent complications and ensure that children with thyroid conditions lead healthy, active lives.
The thyroid may be small, but when it becomes overactive, its effects are anything but minor.
Staying alert to the signals it sends can make all the difference.
Dr Jeanne Wong Sze Lyn is a consultant paediatrician and paediatric endocrinologist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
