Ipertiroidismo e tiroidite autoimmune in età evolutiva

Hyperthyroidism is a rare clinical entity in paediatric age. In most cases the etiology is autoimmune and goiter represents the typical presentation. Ophthalmopathy is rare and can precede the diagnosis of autoimmune hyperthyroidism. Thyrotoxicosis caused by the hyperthyroid phase of Hashimoto’s thyroiditis must be carefully distinguished from Graves’ disease (GD), since the first condition has a better prognosis for spontaneous remission. Three treatment options are currently available for the management of paediatric GD. First-line therapy is antithyroid drugs, while thyroidectomy and radioiodine are considered on relapse. A lower remission rate and a higher risk of adverse events are observed after the first course of methimazole in childhood with respect to adulthood. Children and adolescents may require a prolonged antithyroid treatment, but an overall consensus regarding the optimal regimen is lacking.

Salmonelle da compagnia

The paper describes the case of 21-month-old child with prolonged fever, vomiting and diarrhoea. After detecting non-typhoidal Salmonella in his stools, medical history has revealed an unexpected source of the infection.

Due giraffe in corsia: una encefalite da Mycoplasma pneumoniae

The article describes the case of an encephalitic involvement during Mycoplasma infection with pneumonia. As it often happens in paediatrics, the peculiarity lies in a nuanced symptomatology that may be underestimated. A repeated anamnesis was important and allowed to manage the case better.

Lettere

Giù le mani dai bambini lo dico io! - Cosa ci salverà, se qualcosa ci salverà - Sei ore di scuola senza pranzo, nessuno ne parla

Vitamina D e letteratura: fatti e misfatti

In the last twenty years, the international scientific literature paid particular attention to vitamin D deficiency. Many pathological conditions, like allergy, asthma, cancers, autoimmune, cardiovascular and infectious diseases were attributed to vitamin D deficiency. Could a single deficit be re-sponsible for such a lot of different illnesses? Probably, it could not. The mistake lies in the interpretation of vitamin D suggested serum level cut-off. Vitamin D Recommended Dietary Allowance (RDA) of 20 ng/dl, which is the estimated need for people at the upper limit of the Gaussian distri-bution, was considered like a cut-off. Instead, almost the entire population (97.5%) shows vitamin D needs inferior to 20 ng/ml. This way, a screening based on a wrong cut-off can lead to a useless over-supplementation.