# A nurse is assessing a 10-year-old child who has been brought to the clinic by their parents due to concerns about recent behavioral changes and physical symptoms. Which assessment finding would be most indicative of hyperthyroidism in this child?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=542025  
> language: ko  
> subject: Child Health

## 문제

A nurse is assessing a 10-year-old child who has been brought to the clinic by their parents due to concerns about recent behavioral changes and physical symptoms. Which assessment finding would be most indicative of hyperthyroidism in this child?

## 보기

1. Weight gain of 5 pounds over the past month with decreased appetite
2. Heart rate of 140 beats per minute with complaints of feeling "jittery" **✔ 정답**
3. Constipation and complaints of feeling cold all the time
4. Dry skin and hair with reports of increased sleepiness

**정답: 2**

## 해설

Tachycardia and nervousness are classic signs of hyperthyroidism in children due to increased metabolic rate. Other options describe hypothyroidism symptoms.

## 심화 해설

Correct Answer: 2. Heart rate of 140 beats per minute with complaints of feeling "jittery"

Understanding Pediatric Hyperthyroidism

Hyperthyroidism in children is most commonly caused by Graves' disease (GD), an autoimmune disorder where antibodies stimulate the thyroid gland to overproduce thyroid hormones [1]. The excess thyroid hormones accelerate the body's metabolism, affecting nearly every organ system. Recognizing the clinical presentation in a 10-year-old is critical because symptoms can be mistaken for behavioral issues or anxiety.

Why the Correct Answer Reflects a Hypermetabolic State

The combination of a heart rate of 140 beats per minute and a subjective feeling of being "jittery" is a classic presentation of a hyperadrenergic state driven by excess thyroid hormone. Thyroid hormones increase the number and sensitivity of beta-adrenergic receptors in the heart and nervous system. This leads to a hyperdynamic cardiovascular state, which is a hallmark sign. A case report of an infant with neonatal hyperthyroidism explicitly documented tachycardia, irritability, and hyperdynamic heart sounds as key presenting features, mirroring the symptoms in an older child [3]. The sensation of jitteriness is a direct neurological manifestation of this sympathetic overdrive.

Analysis of Incorrect Options

Option 1: Weight gain of 5 pounds over the past month with decreased appetite

This finding is suggestive of hypothyroidism, not hyperthyroidism. In a hypermetabolic state, the body's basal metabolic rate is significantly elevated. Children with untreated hyperthyroidism typically present with weight loss despite having a normal or even increased appetite, as their caloric expenditure outpaces intake. A case of an 11-year-old male with Graves' disease specifically presented with weight loss as a primary symptom, not weight gain [4].

Option 3: Constipation and complaints of feeling cold all the time

These are classic symptoms of a slowed metabolism due to hypothyroidism. Thyroid hormones are essential for gut motility and thermogenesis. In hyperthyroidism, the opposite occurs: increased gastrointestinal motility often leads to frequent bowel movements or diarrhea, and peripheral vasodilation combined with increased heat production causes heat intolerance and excessive sweating. The case report of the child with Graves' disease confirmed heat intolerance and excessive sweating as presenting complaints, which directly contradicts the symptoms of feeling cold and being constipated [4].

Option 4: Dry skin and hair with reports of increased sleepiness

This cluster of symptoms points toward a hypothyroid state, where decreased metabolic activity leads to reduced sweating, sebaceous gland secretion, and overall energy production. In contrast, the skin of a hyperthyroid child is often described as warm, moist, and smooth due to vasodilation and increased sweating. The profound fatigue of hypothyroidism differs from the restless, agitated state seen in hyperthyroidism, where sleep disturbances and irritability are more common, as noted in neonatal and pediatric cases [3,4].

Key Clinical Reasoning for the NCLEX-RN

When assessing a child with behavioral changes, the nurse must differentiate psychiatric or developmental causes from an underlying endocrine disorder. Tachycardia that persists at rest, coupled with a report of feeling jittery, is a critical red flag that should prompt an investigation of thyroid function, specifically a suppressed thyroid stimulating hormone (TSH) and elevated free thyroxine (FT4) and triiodothyronine (T3) levels, as was the diagnostic pattern in pediatric Graves' disease cases [4]. The cardiovascular system's response to excess thyroid hormone makes the combination of objective tachycardia and subjective nervousness the most specific indicator among the options provided.References (research sources)

- [1]Clinical Pattern of Graves' Disease and Management Preferences Among Pediatric Endocrinologists in Saudi Arabia, A Decade of Experience.Research articleAl Shaikh A, AlNoaim K, Al Dubayee M, Mulla J, Al Hakim S, Alsofyani A, Ahmed ME, Shirah B, Babiker A. (2026) · DOI: 10.1177/11795514261433746

- [3]Neonatal hyperthyroidism with myocardial injury: a case report.Case reportJunhua T, Qiuyan J, Ranfeng L. (2026) · DOI: 10.3389/fped.2026.1767859

- [4]Case Report: Resolution of complete heart block following vitamin D supplementation in a child with Graves disease.Case reportIlmer S, Salemi P. (2025) · DOI: 10.3389/fendo.2025.1680344

## 임상 시나리오

Clinical Practice Guide: Pediatric Hyperthyroidism Assessment

When a school-age child presents with behavioral changes and physical complaints, hyperthyroidism must be differentiated from primary anxiety or behavioral disorders. The hallmark is a constellation of **hypermetabolic and hyperadrenergic signs**.

Key Assessment Findings

- **Cardiovascular:** Persistent resting tachycardia, palpitations, widened pulse pressure, and hyperdynamic precordium. A heart rate of 140 bpm in a 10-year-old is a red flag.

- **Neurological:** Fine tremors, jitteriness, hyperreflexia, and emotional lability that parents may describe as “nervousness” or “anxiety.”

- **Constitutional:** Weight loss despite a normal or increased appetite, heat intolerance, and excessive sweating.

- **Ocular:** Lid lag, stare, or proptosis, especially if Graves' ophthalmopathy is present.

- **Neck:** A palpable, smooth, non-tender goiter with or without a thyroid bruit.

Nursing Actions and Triage

- **Immediate Priority:** Obtain a full set of vital signs, including blood pressure. Evaluate for signs of thyroid storm if extreme tachycardia, hyperthermia, or altered mental status are present.

- **Focused History:** Document onset and progression of symptoms, family history of autoimmune thyroid disease, recent growth patterns on growth charts, and academic performance changes.

- **Diagnostic Support:** Anticipate orders for serum TSH (suppressed), free T4 (elevated), and T3 (elevated). Thyroid-stimulating immunoglobulin testing confirms Graves' disease.

- **Patient Education:** Explain that symptoms like jitteriness and rapid heart rate are physiological, not purely behavioral. Reassure families that medical management with antithyroid drugs or beta-blockers for symptom relief is effective.

## 핵심 개념

- **Hyperthyroidism** — A condition of excessive thyroid hormone production leading to a hypermetabolic state, often causing tachycardia, weight loss, and nervousness.
- **Graves' Disease** — An autoimmune disorder and the most common cause of hyperthyroidism in children, where antibodies stimulate the thyroid-stimulating hormone receptor, causing gland overactivity.
- **Hyperadrenergic State** — A clinical condition mimicking sympathetic nervous system overactivity, induced by excess thyroid hormones increasing beta-adrenergic receptor sensitivity.
- **Tachycardia** — An abnormally rapid heart rate; a heart rate of 140 bpm in a 10-year-old at rest is significantly elevated and a key sign of hyperthyroidism.

## 같은 주제 문제

- [A nurse is assessing a 10-year-old child with suspected hyperthyroidism. Which assessment …](https://mymerci.kr/pages/nclex_q.php?qn_id=542026)
- [A 6-year-old child with hyperthyroidism is receiving methimazole therapy. Which nursing in…](https://mymerci.kr/pages/nclex_q.php?qn_id=542027)
- [A 12-year-old child with hyperthyroidism is receiving methimazole therapy. Which nursing i…](https://mymerci.kr/pages/nclex_q.php?qn_id=542028)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._