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      Thyrotoxicosis in a 13‐year‐old girl following pituitary adenectomy for Cushing′s disease

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          Key Clinical Message

          Our objective is to report a case of thyrotoxicosis following pituitary adenectomy for Cushing′s disease, the only pediatric case to our knowledge. No thyroid antibodies were detected, and the thyrotoxicosis was successfully treated for 3 months with no relapse after 5 years of follow‐up. The cause of thyrotoxicosis remains unknown.

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          Most cited references 16

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          Effect of iodinated contrast media on thyroid function in adults.

          Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast medium solutions contain small amounts of free iodide and may be of significance for patients at risk. The free iodide may also interfere with nuclear medicine diagnostic studies and treatment. Therefore the Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature on this subject in order to prepare guidelines. A report and guidelines were prepared based on an extensive Medline search. The report was discussed with the participants attending the Tenth European Symposium on Urogenital Radiology, Uppsala, Sweden, September 2003. Contrast medium induced thyrotoxicosis is rare. Contrast medium injection does not affect thyroid function tests (e.g., T3, T4, TSH) in patients with a normal thyroid. Routine monitoring of thyroid function tests before contrast medium injection in patients with a normal thyroid is not indicated even in areas where there is dietary iodine deficiency. Patients at risk of developing thyrotoxicosis after contrast medium injection are patients with Graves' disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency. Patients at high-risk should be carefully monitored by endocrinologists after contrast medium examinations. Prophylaxis in these groups is not generally recommended, although it may offer some protection in selected high-risk individuals. The free iodide load of contrast media injections interferes with iodide uptake in the thyroid and therefore compromises diagnostic thyroid scintigraphy and radio-iodine treatment of thyroid malignancies for 2 months after administration of contrast media. Simple guidelines on the subject are proposed.
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            Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988. A nationwide study.

            The objective of this study was to ascertain the annual incidence density of thyrotoxicosis in children under the age of 15 years in Denmark in 1982-1988. The design was based on computerized hospital registration of patient admittances in all departments of paediatrics and internal medicine of Denmark (Faroe Islands and Greenland excluded). Fifty-six children (48 girls and 8 boys) had a confirmed diagnosis of thyrotoxicosis, giving a national incidence density of 0.79/100,000 person-years. In children aged 0-4 years the incidence was very low (0.1/100,000), with no sex difference. In boys aged 5-9 years a similar low incidence was found, while in boys aged 10-14 years the incidence increased to 0.48/100,000. In girls aged 5-9 years the incidence increased to 0.96/100,000, reaching a maximum of 3.01 in the 10-14-year-old girls. In children of > 4 years of age a female preponderance of 6.7:1 was significant. It is concluded that thyrotoxicosis is a rare disorder in Danish children under the age of 15 years, and the incidence increases with age. Female preponderance is significant from early childhood.
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              Prepubertal Cushing's disease is more common in males, but there is no increase in severity at diagnosis.

              Sex distribution and severity of biochemical indices at the diagnosis of Cushing's disease (CD) were analyzed in 50 patients (21 males and 29 females; aged
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                Author and article information

                Contributors
                arndis.sigmarsdottir@karolinska.se
                Journal
                Clin Case Rep
                Clin Case Rep
                10.1002/(ISSN)2050-0904
                CCR3
                Clinical Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2050-0904
                06 July 2017
                August 2017
                : 5
                : 8 ( doiID: 10.1002/ccr3.2017.5.issue-8 )
                : 1341-1343
                Affiliations
                [ 1 ] Department of Pediatrics Children′s Hospital Iceland Landspitali University Hospital Reykjavik Iceland
                [ 2 ] Department of Neurosurgery Landspitali University Hospital Reykjavik Iceland
                [ 3 ] Department of Radiology Landspitali University Hospital Reykjavik Iceland
                [ 4 ] Faculty of Medicine University of Iceland Reykjavik Iceland
                Author notes
                [* ] Correspondence

                Arndis Audur Sigmarsdottir, Department of Pediatrics, Children´s Hospital Iceland, Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland. Tel: +46 851770000; E‐mail: arndis.sigmarsdottir@ 123456karolinska.se

                Article
                CCR31049
                10.1002/ccr3.1049
                5538062
                © 2017 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                Page count
                Figures: 0, Tables: 0, Pages: 3, Words: 2090
                Product
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                ccr31049
                August 2017
                Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.4 mode:remove_FC converted:01.08.2017

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