Skip to main content
Log in

Neuropsychiatric aspects of pediatric thyrotoxicosis

  • Special Article
  • Published:
The Indian Journal of Pediatrics Aims and scope Submit manuscript

Abstract

The neurobehavioural and neuropsychiatric changes associated with thyrotoxicosis are multiple and varied. This association is well recognised although the true incidence of neuropsychiatric symptoms in thyrotoxicosis is not known. Review of available literature suggests that frank psychiatric symptoms in thyrotoxicosis may be in the order of 10%. In pediatric thyrotoxicosis the neuropsychiatric symptoms may be pronounced and may antedate the medical diagnosis by six months to one year. One of the classic presentation is deterioration in school performance. Frequently noticed cognitive and behavioural abnormalities in pediatric thyrotoxicosis are hyperactivity, irritability or anxious dysphoria, and problems of attention. Successful treatment of thyrotoxicosis usually leads to resolution of the major mental disturbances associated with it and delayed treatment possibly results in enduring neuropsychiatric problems. Awareness of neuropsychiatric symptomatology can help in early detection and appropriate management of children with thyrotoxicosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Graves RJ. Newly observed affection of the thyroid gland in the females.London Med Surg J 1835;7: 516–525.

    Google Scholar 

  2. Parry CH. Collections from the unpublished writings of the late CH Parry. Vol. 2. London; Underwoods, 1825.

    Google Scholar 

  3. Saxena KM, Crawford JD, Talbot NB. childhood thyrotoxicosis: A long-term perspective.Br Med J 1964; 2: 1153–1158.

    PubMed  CAS  Google Scholar 

  4. Barnes H, Blizzard RM. Antithyroid drug therapy for toxic diffuse goiter (Grave’s disease): thirty year experience in children and adolescents.J Pediatr 1977; 91: 313–320.

    Article  PubMed  CAS  Google Scholar 

  5. Bhatara V, McMillan MJ, Kummer M. Fire setting and aggressive behaviour in a four year old boy associated with ingestion of ground beef contaminated with bovine thyroid tissue: A case report and review of neuropsychiatric findings in pediatric thyrotoxicosis.J Child Adoles Psychopharmacol 1995; 5: 255–271.

    Google Scholar 

  6. Bhatara V, McMillan MJ. Behavioural and cognitve abnormalities associated with pediatric throtoxicosis. In: Hauser P, Rovet J. (eds).Thyroid Disease of Infancy and Childhood: Effects on Behavioural and Intellectual Development. Washington DC: American Psychiatric Press (in press).

  7. Bhatara V, McMilan MJ, Terv R, Bandettini F. Learning disorders and the thyroid.J Am Child Adolesce Psychia (letter) 1996, 35: 406.

    Article  CAS  Google Scholar 

  8. Vanderpump MPJ, Turnbridge WMG. The epidemiology of thyroid disease. In: Braverman L and Utiger R, (eds).Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. Seventh Edition. Lippincott-Raven, Philadelphia, 1996; pp 474–482.

    Google Scholar 

  9. Stern RA, Prange AJ. Neuropsychiatric aspects of endocrine disorders. In: Kaplan H, Saddock B. (eds).Comprehensive Text Book of Psychiatry VI, Vol 1. 6th edition. Williams and Wilkins, Baltimore, 1995; pp. 241–245.

    Google Scholar 

  10. Stern RA, Robinson B, Thorner AR, Arruda JE, Prohaska ML, Prange AJ. A survey study of neuropsychiatric complaints in patients with Graves’ disease.J Neuropsychiatr Clin Neurosci 1996; 8: 181–185.

    CAS  Google Scholar 

  11. Reus V. Psychiatric aspects of thyroid disease. In: Joffe RT and Levitt AJ. (eds)Thyroid Axis and Psychiatric Illness. American Psychiatric Press, Washington DC, 1993; pp 171–195.

    Google Scholar 

  12. Whybrow PC. Behavioural and psychiatric aspects of thyrotoxicosis. In: Braverman L and Utiger R (eds.)Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text, Seventh Edition: Lippincott-Raven, Philadelphia, 1996; pp. 696–700.

    Google Scholar 

  13. Money J, Drash P. Juvenile thyrotoxicosis: symptoms and antecedents leading to referral and diagnosis.J? Special Ed 1967; 2: 83–91.

    Article  Google Scholar 

  14. Money J, Weinberg R, Lewis V. Intelligence quotient and school performance in twenty two children with a history of thyrotoxicosis.Bull John Hopkins Hosp 1996; 118: 275–281.

    Google Scholar 

  15. Vaidya VA, Bongiovanni A, Parks J, Tenore A, Kirkland R. Twenty two years experience in the medical management of juvenile thyrotoxicosis.Pediatrics 1974; 54: 565–570.

    PubMed  CAS  Google Scholar 

  16. Kogut M, Kaplan S, Colipp P. Tiamsic T, Boyle D. Treatment of hyperthyroidism in children: analysis of forty five cases.N Engl J Med 1965; 272: 217–221.

    Article  PubMed  CAS  Google Scholar 

  17. Menon PSN and Singh GR. Hyperthyroidism in children: An Indian experience.J Pediatr Endocrino Metab 1996; 9: 441–446.

    CAS  Google Scholar 

  18. Aiello DP, DuPlessis AJ, Pattishall EG III,et al. Thyroid storm presenting with coma and seizures.Clin Pediatr 1989; 28: 571–573.

    Article  CAS  Google Scholar 

  19. Daneman D, Howard NJ. Neonatal thyrotoxicosis: intellectual impairment and craniosynostosis in later years.J Pediatr 1980; 97: 257–259.

    Article  PubMed  CAS  Google Scholar 

  20. Hollingsworth DR, Mabry CC. Congenital Graves’ disease.Am J Child 1976; 130: 148–151.

    CAS  Google Scholar 

  21. Wilroy R, Etteldorf J. Familial hyperthyroidism including two siblings with neonatal Graves’ disease.J Pediatr 1971; 78: 625–632.

    Article  PubMed  Google Scholar 

  22. Caudill T, Lardinois C. Severe thyrotoxicosis presenting as acute psychosis.Wset J Med 1991; 155: 292–293.

    CAS  Google Scholar 

  23. Beyer J, Burke M, Meglin D, Fuller A, Krshnan RR, Nemeroff CB. Organic anxiety disorder: Iatrogenic hyperthyroidism.Psychosomatics 1993; 34: 181–184.

    PubMed  CAS  Google Scholar 

  24. American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders 4th edition, APA Press, Washington. DC, 1994.

    Google Scholar 

  25. Alvarez MA, Gomez A, Alvez E, Navarro D. Attention disturbance in Graves’ disease.Psychoneuroendocrinology 1983; 8: 451–454.

    Article  PubMed  CAS  Google Scholar 

  26. Alvarez MA, Guell R, Chong D, Rovet J. Attentional processing in hyperthyroid children before and after treatment.Pediatr Endocrinal Metab 1996; 9: 1–8.

    Google Scholar 

  27. Spencer T, Beiderman J, Wilens T, Guite J, Harding M. ADHD and thyroid abnormalities: a research note.J Child Psychol Psychiat 1995; 36: 879–885.

    Article  PubMed  CAS  Google Scholar 

  28. Weiss RE, Stein MA, Trommer B, Refetoff S. Attention-deficit hyperactivity disorder and thyroid function.J Pediatr 1993; 123: 539–545.

    Article  PubMed  CAS  Google Scholar 

  29. Weller E, Weller R, Svadjian H. Mood disorders. In: Lewis M, (ed).Child and Adolescent Psychiatry. A Comprehensive Textbook. Williams and Wilkins, Baltimore, 1996; pp 650–665.

    Google Scholar 

  30. Anand KJS, Nemeroff CB. Developmental Psychoneuroendocrinology. In: Lewis M, (ed).Chld and Adolescent Psychiatry: A Comprehensive Textbook. Williams and Wilkins, Baltimore, 1996; pp 64–86.

    Google Scholar 

  31. Bernal J, Nunez J. Thyroid hormones and brain development.Eur J Endocrinol 1995; 133: 390–398.

    PubMed  CAS  Google Scholar 

  32. Dassault JH, Ruel J. Thyroid hormones and brain development.Ann Rev Physiol 1987; 49: 321–334.

    Article  Google Scholar 

  33. Delong GR. The neuromuscular system and brain in thyrotoxicosis. In: Braverman L and Utiger R. (eds).Werner and Ingbar’s The Thyroid: A Fundamental and Clinical Text. Seventh Edition. Lippincott-Raven: Philadelphia, 1996; pp 645–652.

    Google Scholar 

  34. Poterfield SP. Vulnerability of the developing brain to thyroid abnormalities: environmental insults to the thyroid.Environ Health Perspect 1994; 102 (supp 2): 125–130.

    Article  Google Scholar 

  35. Dratman MB. Cerebral versus peripheral regulation and utilization of thyroid hormones. In: Joffe R and Levitt A. (eds).Thyroid Axis and Psychiatric Illness. APA Press, Washington DC, 1993; pp. 1–94.

    Google Scholar 

  36. Patel A, Lewis P, Bailey P. Effects of thyroxine on postnatal cell acquisition in the rat brain.Brain Res 1979; 35: 57–72.

    Article  Google Scholar 

  37. Pavlides C, Westlind-Danielsson A, Nyborg Het al. Neonatal hyperthyriodism disrupts hippocampal LTP and spatial learning.Exp Brain Res 1991; 85: 559–564.

    Article  PubMed  CAS  Google Scholar 

  38. Lauder JM. The effects of early hypo and hyperthyroidism on the development of rat cerebral cortex: kinetics of cell proliferation in the external granular layer.Brain Res 1977; 126: 31–51.

    Article  PubMed  CAS  Google Scholar 

  39. Leo RJ, Khin NA, Cohen GN. ADHD and thyroid dysfunction.J Am Acad Child Adolesc Psychiatry 1996; 35: 1572–1573 (letter).

    Article  PubMed  CAS  Google Scholar 

  40. Bhatara V, Kummer M, McMillian MJ, Bandettinen F. Screening for thyroid diseases in ADHD.ADHD Reports 1994; 2 (4): 7–9.

    Google Scholar 

  41. Eberle A. Hyperactivity and Graves’ disease.J Am Acad Child Adolesc Psychiatry 1995; 34: 973 (letter).

    Article  PubMed  CAS  Google Scholar 

  42. Bhatara V, Kummer M, McMillan MJ, Bandettinin F. ADHD and the thyroid.J am Acad Child Adolesc Psychiatry 1994; 33: 1057 (letter).

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bhatara, V.S., Sankar, R. Neuropsychiatric aspects of pediatric thyrotoxicosis. Indian J Pediatr 66, 277–284 (1999). https://doi.org/10.1007/BF02761219

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02761219

Key words

Navigation