Dr. Kaflo: Sometimes kids seems to have an increase hot rating maybe sweat and they cannot concentrate and they go to the pediatrician and they send him through not a cardiologist, but endocrinologist. Is that make sense to you?
Doctor: The symptoms Dr. Kaflo that you are just referring are typical symptom since in children who have hyperthyroidism or elevated thyroid hormone levels in the body. This is fairly common condition and would account for a rapid beating of the heart and the chest or sometimes children in tend to refer to butterflies in the chest.
However, in almost all children perhaps 99.9% of them, if they in fact have over production of thyroid hormone and those symptoms, they would have a swelling of the thyroid gland and the neck called “a goiter”. And if the child does not have a goiter, it is likely to be due to the thyroid. Therefore, when a child complaints of a rapid heartbeat, a example examination by the primary care provider and pediatrician should be able to detect the goiter and if the goiter is present then mostly likely what we are dealing with is a thyroid abnormality where the thyroid gland is producing for reasons that are entirely clear. Too much thyroid hormone causing symptoms of rapid heartbeat, sometimes muscle fatigue and children will have difficulty for example climbing stairs or getting up from a squatting position, weight loss that is unintended and a feeling perhaps of restlessness, anxiety and feeling hot when everybody else maybe feeling cold.
Doctor Kaflo: How this treated if you do a diagnosis?
Doctor: There are three main methods of treatment of an overactive thyroid gland called Graves’s disease. The first and the one that we less prefer are surgical removal of the thyroid gland. Here a surgeon would make a small incision in the neck and remove the thyroid gland. The reason that this is not favored is due to the fact that there are many vital structures in the neck that course through and round the thyroid gland including important nerves and blood vessels. And the since the other two treatments are much more acceptable and less fraud with complications, we prefer them.
The next and the second most favorite treatment is the treatment with pills. These pills will suppress the ability of the thyroid gland to make thyroid hormone. And in doing so, reduce the levels of thyroid hormone in the body typically children are treated with these pills for period of about two years. After which time, if the thyroid gland reverse back to its normal function, the child is cured unfortunately this occurs in only a small minority of patience perhaps 30% to 35% and the rest need to go on to what we consider to be the most favorite approach which is destruction of the thyroid gland using radioactive iodine.
Now living times where radioactivity is something that frightening to most people, but it is important to remember that a very small dose of radioactive iodine is given to the child to drink either in pill form or liquid. That radioactive iodine is absorb very quickly by the thyroid gland the thyroid gland painlessly is destroyed by the radioactive iodine over a period of six to nine weeks. At which point, the thyroid gland is no longer capable of making thyroid hormone.
In essence, we trade the condition of overactive thyroid disease to create in under active thyroid gland and then replace the thyroid hormone with thyroid hormone in pill form. And once children are on unstable dose of thyroid hormone by pill form, their care can be fairly light in the sense that they need to be seen no more than perhaps once or twice a year by the pediatric endocrinologist.
Dr. Kaflo: So when you trade a difficulty treat problem to rather easy treated problems, is that correct?
Doctor: Exactly. Treatment of overactive thyroid gland is much more tricky than treating an under active thyroid gland. Much more close monitoring of the side effects of the pills has to be done and many more changes in the pills have to be done periodically in order to maintain the thyroid hormone levels at a normal range.
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