For children
Especially with children it is important to recognize thyroid gland dysfunctions in time. An overactive thyroid (hyperthyroidism) can lead to various symptoms. These typically include an enlarged thyroid gland, a rapid pulse, high blood pressure, trembling of the extremities and possibly protrusion of the eyes.
Overactive thyroid glands in children can be caused by (usually benign) nodes (adenomas) of the thyroid gland, which, decoupled from the normal control circuit of the thyroid gland, produce thyroid hormones. Other causes can be autoimmune processes, an overdose of thyroid medication or a transmission of thyroid antibodies during pregnancy by the mother. Usually, hyperthyroidism in children is quickly detected, as the corresponding blood values are already examined during the first days of life as part of the U2 examination.
If there are indications of a corresponding functional disorder, ultrasound examinations or, in exceptional cases, a scintigraphy can confirm the diagnosis. Depending on the cause, treatment is then carried out either with medication or surgically. Irradiation of the thyroid gland with intravenously administered radioactive iodine may also be considered.
Follow-up treatment consists of a sufficient iodine supply and possibly hormone replacement therapy.Scintigraphy of a female patient with hyperthyroidism. The uptake of radioactively labelled iodine is highly increased across the entire thyroid gland. From this it can be deduced that the thyroid gland is overactive (hyperthyroidism). This suspicion can be confirmed by determining the so-called thyroid gland values in the blood.
Diagnosis
In the collection of the medical history (= anamnesis) it must be asked whether iodine-containing medication was taken or iodine-containing ointments/tinctures were applied to the skin or whether an examination with X-ray contrast medium containing iodine was performed. This additional iodine intake could have led to hyperthyroidism. The symptoms of an overactive thyroid (hyperthyroidism) are determined during the clinical examination, e.g. an increased heart rate and high blood pressure values, or are asked.
The physical examination of the patient is followed by an examination of the metabolic situation: A laboratory check is performed to determine the levels of thyroid hormones T3 and T4 and the TSH concentration in the blood: The concentrations of the hormones T3 and T4 are elevated and the TSH level is lowered due to the negative feedback from the thyroid hormones to the superior centers. If Graves’ disease is suspected, the TSH autoantibodies can be detected in the blood. The imaging procedures used to diagnose hyperthyroidism include ultrasound (=sonography) and scintigraphy.
Ultrasound is an indispensable method for detecting thyroid diseases: Statements about abnormalities in the structure of the tissue and the echo pattern of the thyroid gland as well as the determination of the volume of the organ are possible. If there is hyperthyroidism, there are many areas of the thyroid gland with low echoes, which appear black in the ultrasound image. The blood supply to the thyroid gland is increased, which can be determined by a Doppler examination (=sonographic procedure to measure the flow rate of blood in the vessels).
Scintigraphy is a radiological examination that can be used to visualize hormone-producing, active cells of the thyroid gland. Scintigraphy is used primarily to diagnose autonomous areas of the thyroid gland. For its visualization, stable iodine is coupled to radioactive technetium and administered to the patient through the vein.
The uptake of iodine into the thyroid gland is therefore linked to the uptake of the radioactive marker, so that the extent of the iodine uptake can be quantified via the representation of the marker in the scintigraphic image. In the case of hyperthyroidism, a large amount of iodine and thus a large amount of technecium is absorbed by the thyroid gland. The areas with stronger storage, called hot nodules, indicate the presence of autonomous thyroid areas.
