Endocrine Abstracts

The term “hyperthyroidism” is a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause of hyperthyroidism in adolescents is Graves’ disease; however, one should also consider other potential reasons such as toxic adenoma (TA) or a toxic multinodular goiter (TMNG), and other rare disorders leading to excessive production and release of thyroid hormones. The term “thyrotoxicosis” refers to a clinical state that results from inappropriately high thyroid hormone action in tissues generally due to inappropriately high tissue thyroid hormone levels. Thyrotoxicosis is a condition having multiple etiologies, manifestations, and potential modes of therapy. By definition, the extrathyroidal source of excessive amounts of thyroid hormones such as iatrogenic thyrotoxicosis, factitious ingestion of thyroid hormone, or struma ovarii does not belong to hyperthyroidism. The etiology of hyperthyroidism/and thyrotoxicosis should be determined. If the diagnosis is not apparent based on the clinical presentation and initial biochemical evaluation, diagnostic testing is indicated. It should include (1) measurement of TRAb, (2) determination of the radioactive iodine uptake (RAIU), or (3) analysis of thyroidal blood flow on ultrasonography. A 123I or 99mTc pertechnetate scan should be obtained when the clinical presentation suggests a TA or TMNG. A question arises whether diagnostic workup and treatment (antithyroid drugs, radioiodine, surgery, others), should be the same in adolescents as in adults, whether there are the same goals of treatment in adolescents as in adults, in females vs. males, in reproductive or post-reproductive age. In this aspect, different treatment modalities may be preferred, to avoid potential risks.