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.