ESPE Abstracts

Thyrotoxicosis refers to a hypermetabolic state that results in excessive amounts of circulating thyroid hormone. Pediatric patients retain significant thymic tissue that regresses only later in life. This thymic tissue can develop significant hyperplasia during an acute autoimmune process. We describe a case of a 14-year-old girl who presented with dysphonia secondary to severe Graves' disease and a 1-month history of goiter, anxiety, restlessness, and tremor. A 99 mTc thyroid scan and thyroid sono revealed diffuse enlarged thyroid without mass. Treatment was initiated with methimazole and b-blocker, with near complete remission of her thyrotoxic symptom within 3 months. After dose adjustment, she visited sudden dysphonia and mild dyspnea with more increasing goiter size. Her thyroid function test showed recurrent hyperthyroidism and even more severe tachycardia and tremor. Simple neck x-ray showed deviated to right and narrowed airway due to enlarged thyroid. She denied stop or incompliance of medication. She had no vocal cord lesions at laryngeal examination. After 2 weeks full dose methimazole, prednisolone, potassium iodide solution and b-blocker, her biochemical parameters were normalized but dysphonia were persisted. For her age, we recommend thyroidectomy instead of radioactive iodine. After total thyroidectomy, she can phonated well. Also, she is presently euthyroid on thyroid hormone replacement and is asymptomatic. Thus, it is concluded that thyroidectomy is considered for pediatric patients with thyrotoxicosis who have dysphonia which is difficult to manage medically.