{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,23]],"date-time":"2025-11-23T06:04:37Z","timestamp":1763877877499,"version":"3.40.5"},"reference-count":19,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,8,1]]},"abstract":"<jats:p>Objective.\u2003Atrial flutter is an uncommon arrhythmia in the pediatric population except for the immediate newborn period or following atrial repair of congenital heart disease. In children the diagnosis of atrial flutter may be difficult, attributable to rapid atrioventricular conduction and superimposition of flutter waves on QRS and T waves. Atrial flutter secondary to hyperthyroidism has been rarely reported in older adults, but there are no reports of children presenting with atrial flutter as the initial manifestation of hyperthyroidism.<\/jats:p>\n               <jats:p>Case Report.\u2003We report an interesting case of hyperthyroidism in a 3-year-old presenting with congestive heart failure and atrial flutter with 1:1 atrioventricular conduction. The responses to adenosine administration and to cardioversion were unusual and ultimately helpful in suggesting the diagnosis of hyperthyroidism.<\/jats:p>\n               <jats:p>Conclusion.\u2003When atrial flutter is encountered in a pediatric patient in whom there is 1:1 atrioventricular conduction, a lack of a response to adenosine, and persistent sinus tachycardia after cardioversion, the clinician should be alert to the possibility of thyrotoxicosis.<\/jats:p>","DOI":"10.1542\/peds.100.2.e11","type":"journal-article","created":{"date-parts":[[2004,8,13]],"date-time":"2004-08-13T23:40:17Z","timestamp":1092440417000},"page":"e11-e11","source":"Crossref","is-referenced-by-count":4,"title":["Atrial Flutter: An Uncommon Pediatric Manifestation of Hyperthyroidism"],"prefix":"10.1542","volume":"100","author":[{"given":"William A.","family":"Suarez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George F.","family":"Van Hare","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isaiah D.","family":"Wexler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James E.","family":"Arnold","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[1997,8,1]]},"reference":[{"key":"2021121109361440300_B1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/clc.4960120109","article-title":"Hyperthyroid-induced atrial flutter-fibrillation with profound sinoatrial nodal pauses due to small amounts of digoxin, verapamil, and propranolol.","volume":"12","author":"Talley","year":"1989","journal-title":"Clin Cardiol"},{"key":"2021121109361440300_B2","first-page":"548","article-title":"Relation of atrial flutter to Graves' disease.","volume":"53","author":"Creigler","year":"1986","journal-title":"Mt Sinai J Med"},{"key":"2021121109361440300_B3","first-page":"245","article-title":"Electrocardiogram in hyperthyroid children.","volume":"119","author":"Pilapil","year":"1970","journal-title":"Am J Dis Child"},{"key":"2021121109361440300_B4","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1016\/0002-8703(72)90041-5","article-title":"A-V conduction in hyper- and hypothyroid dogs.","volume":"83","author":"Goel","year":"1972","journal-title":"Am Heart J"},{"key":"2021121109361440300_B5","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1016\/S0735-1097(85)80497-6","article-title":"Atrial flutter in the young: A collaborative study of 380 Cases.","volume":"6","author":"Garson","year":"1985","journal-title":"J Am Coll Cardiol"},{"key":"2021121109361440300_B6","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1001\/archinte.1988.00380030132023","article-title":"FI, Harada ASM. Graves disease.","volume":"148","author":"Nordyke","year":"1988","journal-title":"Arch Intern Med"},{"key":"2021121109361440300_B7","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/S0022-3476(77)80843-3","article-title":"Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents.","volume":"91","author":"Barnes","year":"1977","journal-title":"Pediatrics"},{"key":"2021121109361440300_B8","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1056\/NEJM196502042720501","article-title":"Treatment of hyperthyroidism in children: analysis of 45 patients.","volume":"272","author":"Kogut","year":"1965","journal-title":"N Engl J Med."},{"key":"2021121109361440300_B9","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1542\/peds.54.5.565","article-title":"Twenty-two years experience in the medical management of juvenile thyrotoxicosis.","volume":"54","author":"Vaidya","year":"1974","journal-title":"Pediatrics"},{"key":"2021121109361440300_B10","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1136\/bmj.2.5418.1153","article-title":"Childhood thyrotoxicosis: a long-term perspective.","volume":"7","author":"Saxena","year":"1964","journal-title":"Br Med J"},{"key":"2021121109361440300_B11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1002\/clc.4960120109","article-title":"Hyperthyroid-induced atrial fibrillation with profound sinoatrial nodal pauses due to small doses of digoxin, verapamil, and propranolol.","volume":"12","author":"Talley","year":"1989","journal-title":"Clin Cardiol."},{"key":"2021121109361440300_B12","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1378\/chest.67.3.350","article-title":"Unusually rapid atrial rate in a patient with thyrotoxicosis and atrial flutter.","volume":"67","author":"Deutsch","year":"1975","journal-title":"Chest"},{"key":"2021121109361440300_B13"},{"key":"2021121109361440300_B14","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1016\/S0300-595X(77)80076-5","article-title":"Catecholamines and hyperthyroidism.","volume":"6","author":"Landsberg","year":"1977","journal-title":"Clin Endocrinol Metab"},{"key":"2021121109361440300_B15","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1016\/0026-0495(76)90126-8","article-title":"Plasma catecholamines in hyperthyroidism and hypothyroidism.","volume":"25","author":"Coluombe, P, Dussault JH, Walker P","year":"1976","journal-title":"Metabolism"},{"key":"2021121109361440300_B16","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1677\/joe.0.0490167","article-title":"Urinary excretion of free catecholamines in Graves' disease.","volume":"49","author":"Bayliss","year":"1971","journal-title":"Endocrinology"},{"key":"2021121109361440300_B17","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/0024-3205(63)90004-3","article-title":"The turnover of norepinephrine in thyrotoxic and nonthyrotoxic mice.","volume":"4","author":"Beaven","year":"1963","journal-title":"Life Sci"},{"key":"2021121109361440300_B18","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/0002-9343(90)90533-J","article-title":"Catecholamine-thyroid hormone interactions and the cardiovascular manifestations of hyperthyroidism.","volume":"88","author":"Levey","year":"1990","journal-title":"Am J Med"},{"key":"2021121109361440300_B19","doi-asserted-by":"crossref","first-page":"95106","DOI":"10.1111\/j.1540-8159.1996.tb04796.x","article-title":"Tachycardiomyopathy. Mechanisms and clinical implications.","volume":"19","author":"Fenelon","year":"1996","journal-title":"PACE"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/2\/e11\/884989\/e11.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/100\/2\/e11\/884989\/e11.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T09:36:29Z","timestamp":1639215389000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/100\/2\/e11\/38921\/Atrial-Flutter-An-Uncommon-Pediatric-Manifestation"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,8,1]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1997,8,1]]},"published-print":{"date-parts":[[1997,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.100.2.e11","relation":{},"ISSN":["1098-4275","0031-4005"],"issn-type":[{"type":"electronic","value":"1098-4275"},{"type":"print","value":"0031-4005"}],"subject":[],"published":{"date-parts":[[1997,8,1]]}}}