# A nurse is assessing a 10-year-old child with suspected hyperthyroidism. Which assessment finding would be most indicative of this condition? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542026 > language: ko > subject: Child Health ## 문제 A nurse is assessing a 10-year-old child with suspected hyperthyroidism. Which assessment finding would be most indicative of this condition? ## 보기 1. Heat intolerance and increased sweating **✔ 정답** 2. Weight gain and constipation 3. Bradycardia and lethargy 4. Cold intolerance and dry skin **정답: 1** ## 해설 Heat intolerance and increased sweating are classic signs of hyperthyroidism in children, reflecting increased metabolic rate from excess thyroid hormones. Other options (weight gain, bradycardia, cold intolerance) are typical of hypothyroidism. ## 심화 해설 Correct Answer: 1. Heat intolerance and increased sweating Hyperthyroidism, most commonly caused by Graves' disease in the pediatric population, results from an excess of circulating thyroid hormones. These hormones, triiodothyronine (T3) and thyroxine (T4), are fundamental regulators of the body's basal metabolic rate. When present in excess, they cause a hypermetabolic state characterized by increased oxygen consumption and heat production. This thermogenic effect directly explains why heat intolerance and excessive sweating are hallmark clinical manifestations. Research on pediatric Graves' disease consistently identifies these as two of the most common presenting complaints. In a cohort of 47 children, heat intolerance was documented in 76.6% of patients and excessive sweating in 74.5%, making them highly sensitive clinical indicators for the condition [1]. The underlying pathophysiology involves the direct stimulation of the sodium-potassium ATPase pump (Na+/K+-ATPase) by thyroid hormones, a primary consumer of cellular energy. This increased enzymatic activity accelerates cellular respiration and heat generation. Simultaneously, the hormones upregulate beta-adrenergic receptors in tissues like the heart, sweat glands, and vasculature, making them more responsive to catecholamines. This synergistic effect leads to the classic sympathetic-like activation symptoms: tachycardia, palpitations (reported in 68.1% of pediatric cases) [1], warm, moist skin from cutaneous vasodilation and increased sweat gland activity, and a subjective feeling of being overly warm in normal-temperature environments. This contrasts sharply with the hypometabolic state of hypothyroidism, where decreased Na+/K+-ATPase activity leads to cold intolerance and dry skin. The other options describe clinical findings associated with hypothyroidism. Weight gain and constipation (Option 2) result from a slowed metabolic rate and reduced gastrointestinal motility. Bradycardia and lethargy (Option 3) are direct consequences of decreased sympathetic stimulation and a low basal metabolic rate. Cold intolerance and dry skin (Option 4) stem from reduced thermogenesis and decreased sweat and sebaceous gland secretion. For the NCLEX-RN, recognizing this direct physiological link—excess thyroid hormone equals a hypermetabolic, heat-generating state—is critical for differentiating hyperthyroidism from its hypothyroid counterpart and for correctly identifying the most expected assessment findings in a pediatric patient.References (research sources) - [1]Pediatric Graves' disease: insights into clinical characteristics and treatment outcomes.Research articleAnand A, Nagarajappa VH, Palany R. (2025) · DOI: 10.20945/2359-4292-2025-0017 ## 임상 시나리오 Pediatric Hyperthyroidism: Clinical Assessment Guide In a 10-year-old child with suspected hyperthyroidism, prioritize assessment for signs of a hypermetabolic state. The most sensitive indicators are **heat intolerance** and **increased sweating**, reported in over 70% of pediatric cases. These reflect direct thermogenic effects of excess T3/T4. During the physical exam, look for additional sympathetic activation signs: tachycardia, palpitations, warm moist skin, and a fine tremor. Do not be misled by symptoms like weight gain, constipation, bradycardia, or cold intolerance, which are hallmark findings of hypothyroidism and indicate a slowed metabolic rate. Key nursing actions include monitoring vital signs with a focus on heart rate and blood pressure, assessing for exophthalmos (a sign of Graves disease), and evaluating growth parameters as hyperthyroidism can accelerate growth velocity initially. Educate the family on the need for medication adherence and avoiding iodine-rich foods. ## 핵심 개념 - **Hyperthyroidism** — A hypermetabolic state caused by excess circulating thyroid hormones (T3 and T4), leading to increased oxygen consumption and heat production. - **Thermogenesis** — The process of heat production in organisms, stimulated by thyroid hormones via increased Na+/K+-ATPase activity and cellular respiration. - **Graves Disease** — An autoimmune disorder and the most common cause of hyperthyroidism in children, characterized by stimulating autoantibodies against the TSH receptor. - **Beta-adrenergic Receptors** — Receptors on tissues like the heart and sweat glands that are upregulated by thyroid hormones, enhancing sensitivity to catecholamines and causing sympathetic-like symptoms. ## 같은 주제 문제 - [A nurse is assessing a 10-year-old child who has been brought to the clinic by their paren…](https://mymerci.kr/pages/nclex_q.php?qn_id=542025) - [A 6-year-old child with hyperthyroidism is receiving methimazole therapy. 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