Thyrotoxicosis due to hyperthyroidism is a serious disorder in childhood often presenting to general paediatricians with a range of clinical manifestations. The commonest cause is Graves’ disease, an autoimmune disorder resulting from thyrotropin receptor stimulation by autoantibodies. Early recognition and accurate interpretation of investigations are essential to achieve and maintain a euthyroid state. This will not only optimise growth, development and transition from childhood to young adult life but also avoid the potentially severe and life-threatening complications of acute thyrotoxicosis. In this review, we have focussed on the general paediatrician’s perspective of the presentation and management of thyrotoxicosis and the need to network with specialist paediatric endocrine centres to optimise patient care. We have discussed nuances of therapy, side effects and long-term outcomes, while recognising that limited remission rates in this age group often necessitate more definitive management. While carbimazole is usually used as first-line medical therapy, we have provided useful information to guide paediatricians in the discussion of individualised safe and effective treatment plans for both short-term and long-term management.

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mean airway pressure (P mean), respiratory rate (RR), expiratory tidal volume (VTe), fraction of inspired oxygen (FiO 2 ) and percentage of time spent in back-up mode. Results Sixty-six episodes of SSC were analysed from 12 premature infants with median gestational age of 24.4 range (23.1-27.0) weeks. Total median duration of SSC was 88.5 (range: 30 -250) minutes. Peak Edi in best SSC median (range) was significantly lower compared to pre-SSC 17.11 (4.04-36.64) microvolts (uV) p <0.001. P mean was significantly lower in best SSC 10.30 (6.79-14.98) and end SSC 10.14 (7.25-15.6) compared to pre-SSC 10.67 (7.49-15.52) cmH2O, p = 0.033 and p = 0.005. RR was lower in best SSC 52.63 (35.59-74.00) and significantly lower in end SSC 52.41 (31.14-78.1) compared to pre-SSC 54.74 (35.11-74.08) breaths/min, p = 0.069 and p = 0.037. VTe was lower in best SSC 40.91 (3.73-100.26) and significantly lower in end SSC 41.50 (3.43-96.87) compared to pre-SSC 42.75 (4.68-92.99) ml p = 0.147 and p = 0.465. There was no statistically significant difference in inspired oxygen requirement in best SSC 39.63 (22.06-54.99) and end SSC 40.31 (22.06-56.05) compared to pre-SSC 39.55 (25.99-56.07), p = 0.878 and p = 0.352. There was no statistically significant difference in the time spent in back-up mode in best SSC 8.52 (0.00-40.33) and end SSC 7.60 (0.00-56.02) compared to pre-SSC 7.04 (0.00-29.30), p = 0.257 and p = 0.800. Conclusion The respiratory parameters of peak electrical activity of the diaphragm (peak Edi), mean airway pressure and respiratory rate were significantly improved in extremely preterm babies receiving SSC.