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Hyperthyroidism and Graves’ Disease

What Is the Thyroid?

The thyroid is a small gland located below the skin and muscles at the front of the neck, just at the spot where a bow tie would rest.

It's brownish red, with left and right halves (called lobes) that look like a butterfly's wings. It usually weighs less than an ounce, but helps the body do many things, such as get energy from food, grow, and go through sexual development.

What Is Thyroid Disease?

Thyroid disease is when the thyroid gland doesn't supply the proper amount of hormones needed by the body.

  • If the thyroid is overactive, it releases too much thyroid hormone into the bloodstream, causing hyperthyroidism. The body use up energy more quickly than it should, and chemical activity (like metabolism) in the cells speeds up.
  • If the thyroid is underactive, it makes too little thyroid hormone, causing hypothyroidism. The body uses up energy more slowly, and chemical activity (metabolism) in the cells slows down.

What Is Hyperthyroidism?

Hyperthyroidism (or overactive thyroid) happens when the thyroid gland sends too much thyroid hormone into the blood.

What Are the Signs & Symptoms of Hyperthyroidism?

Hyperthyroidism can cause nervousness, irritability, increased sweating, bulging eyes, difficulty sleeping, a fast heartbeat, irregular menstrual periods in girls, and weight loss. In some kids with hyperthyroidism, the thyroid gland can swell up, causing a bulge in the neck called a goiter.

Medicine and other treatments can help kids and teens with hyperthyroidism lead normal, healthy lives.

What Is Graves' Disease?

Graves' disease, an autoimmune disease, is the most common cause of hyperthyroidism.

It makes the immune system produce abnormal types of antibodies (normally, antibodies help the body fight infection). These abnormal antibodies make the thyroid gland produce more thyroid hormones.

What Are the Signs & Symptoms of Graves' Disease?

Kids and teens with Graves' disease might lose weight even though they're eating more than usual. Their eyes may feel irritated or look like they're staring. Sometimes the tissues around the eyes become inflamed and swollen, and the eyes appear to bulge out, but this is more common in adults with hyperthyroidism.

Eventually, the thyroid gland enlarges, and can lead to a goiter. For reasons that doctors don't yet understand, autoimmune thyroid diseases like Graves' disease are much more common in women and are most likely to affect teens and young and middle-aged adults.

How Is Graves' Disease Diagnosed?

Doctors usually diagnose Graves' disease based on a person's symptoms, a physical examination, and blood tests that show high levels of thyroid hormone in the blood. 

How Is Graves' Disease Treated?

Kids and teens with Graves' disease will usually start taking an anti-thyroid medicine, which blocks the thyroid's production of thyroid hormones. The medicine usually brings the hormone levels down to the normal range in 1 to 2 months.

In most cases, though, the disease doesn't go away. Some people continue taking medicine for months or years to keep Graves' disease under control. If a child still has hyperthyroidism after a few years of taking medicine or has problems taking the medicine, doctors may consider permanent treatments to stop the thyroid from making too much thyroid hormone.

Permanent Treatments

Radioactive iodine (RAI) is the most commonly recommended permanent treatment for older kids and teens with Graves' disease. Although usually given at a hospital, it doesn't require a hospital stay. RAI is considered safe when given in the standard amount. It is taken in capsules or mixed with a glass of water. The thyroid gland quickly absorbs the RAI from the bloodstream and, within a few months, the gland shrinks and symptoms gradually disappear. RAI has been used to treat Graves' disease successfully for more than 50 years.

The other permanent treatment for Graves' disease is surgery to remove most of the thyroid gland (called a thyroidectomy). The operation is done in a hospital under general anesthesia, so the child or teen is asleep and feels nothing during the surgery. A small incision (cut) in the lower central part of the neck usually leaves a thin scar.

After surgery, there's often swelling in the area of the incision. Some kids and teens may have a sore throat and some trouble swallowing following surgery, although they should be able to eat and drink normally. These symptoms usually disappear within a few days.

What Else Should I Know?

After treatment for hyperthyroidism, hormone production often slows down to hypothyroid (underactive) levels, so the person needs to take a thyroid hormone replacement tablet each day. This treatment is a lot easier to manage than taking pills to control the hyperthyroidism — fewer blood tests, doctor visits, and medicine adjustments are necessary.

As the body adjusts to the hormone replacement tablets, a doctor may increase or reduce the dosage until the levels of thyroid hormone are normal. When the doctor finds the proper dosage, people usually feel well and free of symptoms. However, the doctor will continue to check hormone levels to make sure the dosage is right, especially for growing teens whose levels might change over just a few months.