ABSTRACT
Grave's disease is the most common cause of hyperthyroidism in children, but it occurs rarely, in about 1 in 100 000 children. Medical treatment with methimazole and beta blockers provides initial treatment. If ineffective, radioactive iodine ablation or, preferably in the children, a total thyroidectomy is required. The high-risk patients require their prophylactic thyroidectomy at or before age 5 depending on the calcitonin levels. Moderate-risk patients have their calcitonin levels followed, and undergo a total thyroidectomy when the calcitonin begins to rise. Hypocalcemia presents with the symptoms of perioral and fingertip numbness and tingling, along with a positive Chvostek's and/or Trousseau's sign. This rarely occurs after a thyroid lobectomy, but it is not uncommon after a total thyroidectomy, and occurs more often following a central neck dissection. However, transient hypocalcemia occurs in 14–34% of the children undergoing a total thyroidectomy.
