What are the main symptoms of subacute thyroiditis. How is subacute thyroiditis diagnosed. What treatment options are available for subacute thyroiditis. Can subacute thyroiditis lead to long-term complications. How long does subacute thyroiditis typically last.

What Is Subacute Thyroiditis and How Does It Affect the Body?

Subacute thyroiditis is a rare inflammatory condition affecting the thyroid gland, a crucial endocrine organ located in the front of the neck. This condition is characterized by inflammation of the thyroid tissue, which can lead to a disruption in hormone production and a cascade of symptoms affecting various bodily functions.

The thyroid gland plays a vital role in regulating metabolism, energy production, and numerous physiological processes. When affected by subacute thyroiditis, the gland’s ability to produce and release hormones is compromised, resulting in a unique pattern of symptoms that typically progress through distinct phases.

The Role of Viral Infections in Subacute Thyroiditis

Unlike other forms of thyroiditis, subacute thyroiditis is believed to have a strong association with viral infections. The condition often develops following an upper respiratory infection, such as influenza or mumps. The viral infection triggers an immune response that leads to inflammation of the thyroid gland, causing it to swell and disrupt normal hormone production.

Demographic Patterns and Risk Factors

Who is most likely to develop subacute thyroiditis? Research indicates that the condition has a slight gender bias, with women aged 40 to 50 being more susceptible than men in the same age group. This demographic pattern suggests potential hormonal or genetic factors that may influence susceptibility to the condition.

Recognizing the Symptoms: From Hyperthyroidism to Hypothyroidism

One of the most distinctive features of subacute thyroiditis is its biphasic nature, characterized by an initial period of hyperthyroidism followed by a phase of hypothyroidism. Understanding these phases and their associated symptoms is crucial for early recognition and proper management of the condition.

Initial Hyperthyroid Phase

During the early stages of subacute thyroiditis, patients typically experience symptoms associated with an overactive thyroid (hyperthyroidism). These may include:

• Irritability and anxiety
• Restlessness and difficulty concentrating
• Sudden weight loss
• Rapid or irregular heartbeat
• Increased body temperature and excessive sweating
• Tremors
• Diarrhea

How long does the hyperthyroid phase typically last? In most cases, this initial stage persists for less than three months, although individual experiences may vary.

Subsequent Hypothyroid Phase

As the condition progresses, the thyroid gland’s function often becomes depleted, leading to a period of underactive thyroid (hypothyroidism). Symptoms during this phase may include:

• Fatigue and weakness
• Hair loss
• Cold intolerance
• Constipation
• Sudden weight gain
• Heavy menstrual periods (in women)
• Depression

The hypothyroid phase can persist for an additional nine to 15 months, highlighting the potentially prolonged nature of subacute thyroiditis.

Unraveling the Subtypes of Subacute Thyroiditis

Subacute thyroiditis is not a monolithic condition but rather encompasses several subtypes, each with its unique characteristics and triggers. Understanding these subtypes can provide valuable insights into the diverse manifestations of the disorder.

Subacute Granulomatous Thyroiditis

This is the most prevalent form of subacute thyroiditis, primarily associated with viral infections. It is characterized by the formation of granulomas (clusters of inflammatory cells) within the thyroid tissue.

Postpartum Thyroiditis

Occurring in women within one year after childbirth, postpartum thyroiditis is thought to be linked to underlying autoimmune processes. It typically resolves within 18 months but may recur in subsequent pregnancies.

Subacute Lymphocytic Thyroiditis

This subtype also occurs during the postpartum period but follows a slightly different timeline. Hyperthyroid symptoms usually develop within three months after delivery, followed by a potentially prolonged hypothyroid phase.

Palpation Thyroiditis

Unlike the other subtypes, palpation thyroiditis is caused by mechanical damage to thyroid follicles. This can result from repeated examination of the thyroid gland or surgical procedures in the neck area.

Diagnostic Approaches: Identifying Subacute Thyroiditis

Accurate diagnosis of subacute thyroiditis is crucial for appropriate management and treatment. Healthcare providers employ a combination of clinical examination, patient history, and laboratory tests to confirm the diagnosis.

Physical Examination

The initial step in diagnosis often involves a thorough physical examination of the neck region. What do doctors look for during this examination? They assess the size and consistency of the thyroid gland, checking for any enlargement or tenderness that might indicate inflammation.

Medical History Assessment

Healthcare providers will inquire about recent symptoms and medical history, paying particular attention to any recent viral infections of the upper respiratory tract. This information can provide valuable clues, given the strong association between subacute thyroiditis and viral illnesses.

Blood Tests: Hormone Level Analysis

Blood tests play a crucial role in confirming the diagnosis of subacute thyroiditis. These tests primarily focus on measuring levels of thyroid hormones and thyroid-stimulating hormone (TSH). What specific hormones are measured?

• Free T4 (thyroxine): A hormone produced directly by the thyroid gland
• TSH (thyroid-stimulating hormone): Produced by the pituitary gland to regulate thyroid function

How do these hormone levels change during subacute thyroiditis? The results typically follow a characteristic pattern:

1. Initial hyperthyroid phase: High free T4 levels and low TSH levels
2. Later hypothyroid phase: Low free T4 levels and high TSH levels

This inverse relationship between free T4 and TSH levels, known as the “internal feedback loop,” is a key diagnostic indicator of thyroid dysfunction.

Treatment Strategies: Managing Subacute Thyroiditis

While subacute thyroiditis often resolves on its own, various treatment options are available to manage symptoms and prevent complications. The approach to treatment typically depends on the severity of symptoms and the phase of the condition.

Pain Management

One of the primary goals of treatment is to alleviate the pain and discomfort associated with thyroid inflammation. What medications are commonly used for pain relief in subacute thyroiditis?

• Nonsteroidal anti-inflammatory drugs (NSAIDs): These are often the first-line treatment for mild to moderate pain.
• Corticosteroids: In cases of severe pain or when NSAIDs are ineffective, corticosteroids like prednisone may be prescribed to reduce inflammation and alleviate symptoms.

Hormone Replacement Therapy

During the hypothyroid phase, some patients may require thyroid hormone replacement therapy to manage symptoms and maintain normal metabolic function. This typically involves the administration of levothyroxine, a synthetic form of the thyroid hormone thyroxine.

Beta-Blockers for Hyperthyroid Symptoms

In the initial hyperthyroid phase, beta-blockers may be prescribed to help manage symptoms such as rapid heart rate, tremors, and anxiety. These medications work by blocking the effects of excess thyroid hormones on the body.

Monitoring and Follow-Up

Regular monitoring of thyroid function through blood tests is essential throughout the course of subacute thyroiditis. This allows healthcare providers to adjust treatment as needed and ensure a return to normal thyroid function.

Long-Term Outlook and Potential Complications

While subacute thyroiditis is often a self-limiting condition, it’s important to be aware of potential long-term implications and complications that may arise.

Recovery and Recurrence

For most individuals, subacute thyroiditis resolves completely within 12 to 18 months, with thyroid function returning to normal. However, a small percentage of patients may experience recurrence or develop permanent thyroid dysfunction.

Permanent Thyroid Damage

In rare cases, subacute thyroiditis can lead to permanent damage to the thyroid gland, resulting in chronic hypothyroidism. This underscores the importance of proper management and follow-up care.

Impact on Future Pregnancies

Women who have experienced postpartum thyroiditis may be at increased risk for recurrence in subsequent pregnancies. Close monitoring of thyroid function during and after pregnancy is often recommended for these individuals.

Preventive Measures and Lifestyle Considerations

While it may not be possible to prevent subacute thyroiditis entirely, certain lifestyle factors and preventive measures can help support overall thyroid health and potentially reduce the risk of complications.

Maintaining a Healthy Immune System

Given the association between viral infections and subacute thyroiditis, taking steps to support immune function may be beneficial. This can include:

• Eating a balanced, nutrient-rich diet
• Getting regular exercise
• Managing stress through relaxation techniques or mindfulness practices
• Ensuring adequate sleep and rest

Regular Health Check-ups

Routine medical check-ups that include thyroid function tests can help detect any thyroid abnormalities early, allowing for prompt intervention if necessary.

Iodine Intake

Maintaining adequate iodine intake is crucial for thyroid health. However, excessive iodine consumption can potentially trigger or exacerbate thyroid problems in some individuals. Consulting with a healthcare provider about appropriate iodine intake is advisable, especially for those with a history of thyroid issues.

Smoking Cessation

Smoking has been associated with an increased risk of various thyroid disorders. Quitting smoking or avoiding secondhand smoke exposure may help reduce the risk of thyroid problems, including subacute thyroiditis.

In conclusion, subacute thyroiditis is a complex condition that requires a comprehensive understanding of its symptoms, diagnosis, and treatment options. By recognizing the signs early and seeking appropriate medical care, individuals can effectively manage the condition and minimize potential long-term complications. As research in this field continues to evolve, new insights and treatment strategies may emerge, offering hope for improved outcomes for those affected by this rare thyroid disorder.

Subacute Thyroiditis: Symptoms, Diagnosis, and Treatments

What is subacute thyroiditis?

Thyroiditis refers to the inflammation of the thyroid. The thyroid is a gland in the front of the neck that releases a variety of hormones. These hormones help regulate metabolism, the process that converts food into energy. They also play a crucial role in your physical and emotional responses, such as fear, excitement, and pleasure.

Thyroiditis includes a group of disorders that cause the thyroid to become inflamed. Most types of thyroiditis typically lead to either hyperthyroidism or hypothyroidism. Hyperthyroidism is a disorder in which the thyroid is overactive and produces too much hormones. Hypothyroidism is a condition in which the thyroid is underactive and doesn’t make enough hormones. Both of these conditions can cause weight changes, anxiety, and fatigue.

Subacute thyroiditis is a rare type of thyroiditis that causes pain and discomfort in the thyroid. People with this condition will also have symptoms of hyperthyroidism and later develop symptoms of hypothyroidism. While often temporary, subacute thyroiditis can cause permanent complications if left untreated.

Unlike other forms of thyroiditis, subacute thyroiditis is thought to be linked to a viral infection. In response to the virus, the thyroid swells and can disrupt hormone production. This causes inflammation and a variety of symptoms.

Subacute thyroiditis is slightly more common in women aged 40 to 50 than it is in men of the same age. It generally occurs after an upper respiratory infection, such as the flu or the mumps.

Unlike other forms of thyroiditis, subacute thyroiditis causes pain in the thyroid gland. In some cases, this pain might also spread to other parts of your neck, ears, or jaw. Your thyroid may be swollen and tender to the touch. The American Thyroid Association estimates that the pain commonly lasts between 1 and 3 months.

Other symptoms of subacute thyroiditis include:

• fever
• fatigue
• weakness
• hoarseness
• difficulty swallowing

Hyperthyroidism symptoms

Most people typically develop hyperthyroidism in the initial stages of subacute thyroiditis. The symptoms during this stage of the disease may include:

• irritability
• anxiety
• restlessness
• trouble concentrating
• diarrhea
• sudden weight loss
• fast or irregular heartbeat
• increased body temperature that often leads to excessive sweating
• tremors

Hypothyroidism symptoms

As the disease progresses, hypothyroidism generally replaces hyperthyroidism in the second stage. The symptoms during the second stage may include:

• fatigue
• hair loss
• cold intolerance
• constipation
• sudden weight gain
• heavy menstrual periods
• depression

The first stage of subacute thyroiditis usually lasts for less than three months. The second stage may last for an additional nine to 15 months.

There are four different subtypes of subacute thyroiditis:

Subacute granulomatous thyroiditis: Thisis the most common type of subacute thyroiditis. It’s mostly caused by viral infections.

Postpartum thyroiditis: This occurs in women within one year after giving birth, and usually goes away within 18 months. Women who develop this form of thyroiditis are thought to have an underlying autoimmune disease that causes the inflammation. Symptoms occur in two phases, starting with hyperthyroid symptoms and moving to hypothyroid symptoms.

Subacute lymphocytic thyroiditis: This also occurs during the postpartum period. Hyperthyroid symptoms develop earlier (usually within three months after giving birth), and hypothyroid symptoms can last for several months after.

Palpation thyroiditis: This develops when thyroid follicles are damaged from mechanical manipulation such as repeated examination of the thyroid gland or surgery.

All of the subtypes of subacute thyroiditis follow a similar course of symptoms, with hyperthyroid developing first. The key differences are the causes.

Your doctor will feel and examine your neck to see if the thyroid gland is enlarged or inflamed. They’ll also ask you about your symptoms and your recent medical history. Your doctor will be more likely to check for subacute thyroiditis if you’ve recently had a viral infection in the upper respiratory tract.

Your doctor will order a blood test to confirm a subacute thyroiditis diagnosis. This test will check the levels of certain hormones in your blood. Specifically, the blood test will measure your thyroid hormone, or free T4, and thyroid stimulating hormone (TSH) levels. The free T4 and TSH levels are part of what’s called an “internal feedback loop.” When one level is high, the other level is low, and vice versa.

The results of the blood test will vary depending on the stage of the disease. In the initial stages, your free T4 levels will be high while your TSH levels will be low. In the later stages, your TSH levels will be high while your T4 levels will be low. An abnormal level of either hormone indicates subacute thyroiditis.

If you’re diagnosed with subacute thyroiditis, your doctor will give you medications to help reduce the pain and control inflammation. In some cases, this is the only treatment required for subacute thyroiditis. Possible medications include:

• Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs). Medications like aspirin and ibuprofen work by reducing inflammation. As a result, you will experience less pain. Acetaminophen (Tylenol) is not as effective because it doesn’t reduce the inflammation thyroiditis causes.
• Corticosteroids. Corticosteroids are used when NSAIDs aren’t enough to reduce swelling. Prednisone is a common corticosteroid used to treat subacute thyroiditis. Your doctor may prescribe 15 to 30 milligrams per day to start, and then slowly decrease the dosage over three to four weeks.
• Beta-blockers. Your doctor may prescribe beta-blockers if hyperthyroidism is present in the early stages. These medications lower blood pressure and pulse rate to relieve certain symptoms, including anxiety and an irregular heartbeat.

Treatment for hyperthyroidism is important at the beginning of the disease. However, it will not be helpful once your condition progresses into the second phase. During the later stages of the disease, you’ll develop hypothyroidism. You’ll probably need to take hormones such as levothyroxine to replace the ones that your body isn’t producing.

Treatment for subacute thyroiditis is usually temporary. Your doctor will eventually wean you off any medications that have been prescribed to treat the condition.

There are no clear preventive measures for subacute thyroiditis because the precise cause is unknown. Recurrence is not common.

In many cases, subacute thyroiditis resolves on its own without warning. The overall prognosis depends on the extent of damage in the thyroid gland. If a lot of damage is done, you might experience permanent thyroid issues and need ongoing medical attention.

The symptoms of subacute thyroiditis usually go away within 12 to 18 months. In some cases, however, hypothyroidism may end up being permanent. The American Thyroid Association estimates that approximately 5 percent of people with subacute thyroiditis develop permanent hypothyroidism. Permanent health problems are extremely rare.

Call your doctor if you suspect you have subacute thyroiditis. Early diagnosis and treatment can help prevent developing permanent hypothyroidism.

Fever – The Pediatric Clinic

What is a fever?

A fever means the body temperature is above normal. Your child has a fever if:

• The rectal temperature is over 100.4° F (38° C).
• The temperature taken by mouth is over 100° F (37.8° C).
• The armpit temperature is over 99.0° F (37.2° C).
• The ear temperature is over 100.4° F (38° C).
• The pacifier temperature is over 100° F (37.8° C).

Fever helps fight infections. Most fevers are not harmful. They may last 2 or 3 days.

How can I take care of my child?

• Use medicine only if the child needs it. Remember that fever helps your child fight the infection. Use medicine only if the fever is over 102° F (39° C) and your child is uncomfortable.
  • You can give acetaminophen (Tylenol) to children older than 3 months. Fever medicine lowers the fever by 2 to 3° F (1 to 1.5° C).
  • You may want to give your child ibuprofen instead. Ibuprofen (Advil) works 2 hours longer than acetaminophen. Give the right dose for your child’s weight, every 6 to 8 hours, as needed. You can give ibuprofen to children over 6 months of age.

• Do not give your child or teen aspirin.
• Sponge your child if the fever does not go down. Sponge your child if your child’s temperature stays over 104° F (40° C) 30 minutes after your child has taken acetaminophen or ibuprofen. Always give your child acetaminophen or ibuprofen first. Sit your child in only 2 inches of lukewarm water. Sponge off the child’s skin. If your child shivers, stop sponging or put in more warm water.
• Have your child drink a lot of cold fluids.
• Have your child wear as little clothing as possible. Do not bundle up your child. It may make the fever go higher.

For fevers of 100 to 102° F (37.8 to 38.9° C), cold fluids and little clothing may be all your child needs. Your child may not need acetaminophen.

Call your child’s doctor right away if:

• Your child is less than 3 months old.
• Your child’s fever is over 104° F (40° C).
• Your child has a seizure.
• Your child looks or acts very sick.

Call your child’s doctor within 24 hours if:

• Your child is 3 to 6 months old (unless the fever is due to an immunization shot).
• Your child has had a fever more than 24 hours and you don’t know what is causing it AND your child is less than 2 years old.
• Your child has had a fever for more than 3 days.
• The fever went away for over 24 hours and then came back.
• You have other concerns or questions.

Fever – Teen Version

What is a fever?

A fever means the body temperature is above normal. You have a fever if your oral temperature is over 99.5°F (37.5°C).

The body’s average temperature when it is measured orally is 97.6°F (36.5°C), but it normally changes during the day. Oral temperature normally can change from a low of 95.8°F (35.5°C) in the morning to a high of 99.4°F (37.5°C) in the late afternoon. Mildly increased temperature (100.4° to 101.3°F, or 38° to 38.5°C) can be caused by exercise, heavy clothing, a hot bath, or hot weather. Warm food or drink can also raise the oral temperature. If you suspect such an effect on your temperature, take it again in a half hour.

How do I take my temperature?

1. Do not have a cold or hot drink for 30 minutes before you take your temperature.
2. Turn on the thermometer if you’re using the digital type.
3. Place the tip of the thermometer under one side of your tongue and toward the back.
4. Wait until the thermometer signals that you can take it out.
5. Read the display on a digital thermometer.

What causes a fever?

Fever is a symptom, not a disease. It is the body’s normal response to infections. Fever helps fight infections by turning on the body’s immune system. Most fevers (100° to 104°F, or 37.8° to 40°C) are not harmful. Most are caused by viral illnesses such as colds or flu. Some are caused by bacterial illnesses such as strep throat or bladder infections.

How long will it last?

Most fevers with viral illnesses last for 2 to 3 days. In general, the height of the fever doesn’t relate to the seriousness of the illness. How sick you feel is what counts. Fever does not cause permanent harm until it reaches 108°F (42°C). Fortunately, the brain’s thermostat keeps untreated fevers below this level.

How can I take care of myself?

• Extra fluids and less clothing

Drink extra fluids. Cold drinks are helpful. Body fluids are lost during fevers because of sweating.

Dress in light clothing because most heat is lost through the skin. During the time you feel cold or are shivering (the chills), wrap yourself in a light blanket.

If the fever is less than 102°F this is the only treatment needed. Fever medicines are not necessary.

• Medicines

Remember that the fever is helping your body fight the infection. Take medicine only if your fever is over 102°F (39°C) and you are also uncomfortable. You should take either acetaminophen or ibuprofen.

Acetaminophen: Take any one of the acetaminophen products: Tylenol, Anacin-3, Panadol, or Tempra. The dosage is 2 tablets (650 mg) every 4 to 6 hours. 2 hours after they are taken, these drugs will reduce the fever 2° to 3°F (1° to 1.5° C). Medicines do not bring the temperature down to normal unless the temperature was not very high before the medicine was taken. You will need to take repeated dosages of the drugs because the fever will go up and down until the illness runs its course.

Ibuprofen: Ibuprofen is available in 200-mg tablets without a prescription as Advil, Motrin, etc. The dosage is 2 tablets (400 mg) of ibuprofen every 6 to 8 hours. When you use ibuprofen, stop taking acetaminophen.

Avoid aspirin: Doctors recommend that anyone under age 21 years) not take aspirin if they have any symptoms of a cold or viral infection, such as a fever, cough, or sore throat. Aspirin taken during a viral infection, such as chickenpox or flu, has been linked to a severe illness called Reye’s syndrome.

When should I call my healthcare provider?

Call immediately if:

• Your fever is over 104°F (40°C).
• You have fever along with a severe headache, confusion, a stiff neck, trouble breathing, or you can’t drink liquids.

Call within 24 hours if:

• Your fever went away for more than 24 hours and then returned.
• You have a fever for more than 3 days.
• You have other concerns or questions.

Fever in children without any symptoms

Fever in a child is the most common symptom faced by parents. Many pathological conditions, such as infectious diseases, heat stroke, blood transfusion, can lead to an increase in body temperature.

By definition, fever is body temperature >38°C. Rectal temperature is most accurate (especially in toddlers, infants, and newborns), as underarm temperatures are less accurate.

The original purpose of fever is to stimulate the body’s defenses to fight infection. An increase in temperature also stimulates an inflammatory response, which leads to the release of protective substances and cells into the damaged or infected area. The fever itself is not harmful. However, fever causes dehydration, which requires its timely correction.

For most children with fever, it’s relatively simple: fever has clinical signs of an identifiable source of infection—viral respiratory infection, acute otitis media, gastrointestinal tract, or viral exanthema. However, about 20% of children show fever without any noticeable clinical signs of the disease.

Prolonged fever of unknown origin is a rise in temperature that lasts longer than usual. For example, more than the seven to ten days expected for a simple viral infection. In many cases, no specific cause of fever is found and it simply stops.

But, on the other hand, the cause of such, at first glance, inexplicable temperature increase can be very dangerous diseases and conditions:

• Urinary tract infection
• Nephrites
• Bacteremia,
• Pneumonia
• Bacterial meningitis.

The most common cause (5%) is an occult urinary tract infection, especially in children under 2-3 years of age. The higher the temperature. The higher the probability of a child having a latent dangerous infection – on average, for every 0.5 degrees, the diagnostic probability of such an infection increases by 50%. But children with an infection as the cause of a fever almost never have a high enough and dangerous temperature (>41.5°C). Such a high temperature is usually observed only with non-infectious causes of hyperthermia.

Unusual diseases such as rheumatological or oncological diseases can also cause prolonged hyperthermia (fever), for 2-3 weeks.

If the child’s vital signs and clinical presentation continue to be of concern even after the child’s temperature has returned to normal, occult infections should also be suspected. However, if the child has normal vital signs and is clinically healthy after the temperature has returned to normal, then the likelihood of infections is very small, and parents can be sure that the fever itself is not dangerous.

If the child develops tachycardia (increased heart rate) after the temperature drops, dehydration and sepsis should be considered. Normally, a child’s heart rate increases by about 10 beats per minute and breathing rate by 5 breaths per minute for every degree Celsius temperature increase in a fever >38°C.

Diagnosing Hidden Causes of a Baby’s Fever

If a doctor examines a child during the first three to five days and finds no other symptoms, they may decide to simply observe your child after a complete physical examination, depending on how whether your child looks healthy or sick. After that, if the fever persists, the pediatrician will likely run additional tests, such as a streptococcal test and a complete blood count.

When diagnosing causes of prolonged fever without an obvious cause, the doctor will evaluate the duration of the fever, recent surgery, comorbidities, previous infections, immunization status (especially at 2 and 4 months of age).

During the physical examination, the doctor will look at the child’s behavior and mental state, assess how the child walks (to rule out septic arthritis/osteomyelitis), and carefully examine the skin, joints, and abdomen. A detailed physical examination may provide additional clues. The pediatrician may especially look for mouth ulcers, rashes, swollen lymph nodes, or classic symptoms of childhood illnesses such as Kawasaki disease.

The doctor will look at the main six causes of an occult bacterial infection that can lead to a fever without noticeable symptoms: 6

Urinary tract infections of childhood are most likely if there is a history of previous similar diseases, fever >39°C for no apparent reason for more than 24 hours, sickly appearance of the child, tenderness in the suprapubic region (or dysuria and back pain or new urinary incontinence in older children). Urinary tract infections are more common in girls and uncircumcised boys. In all cases, it is recommended to pass a urine test (with culture), which will confirm or exclude the alleged diagnosis. Also, for diagnostic purposes, ultrasound of the kidneys and cystourethrography are performed.

A few weeks after the child becomes ill, an additional examination is carried out. This may include an abdominal ultrasound or CT scan to look for an occult abscess, a stool culture, an arthritis test, a thyroid function test, and antibody testing. If everything is normal, testing for non-infectious causes of fever, such as juvenile rheumatoid arthritis, malignancies, and inflammatory bowel disease, usually follows.

Children under 2 months of age and with seizures may need hospitalization. The treatment is carried out with the help of antibiotics and control of the hydration of the child’s body. Options for the use of antibiotics depend on the resistance of the pathogen. In a hospital setting, ampicillin and gentamicin are used. For home use by mouth, a doctor may prescribe cephalexin for most children or cefixime for infants 2-6 months of age, especially if there are urinary tract complications or abnormalities.

If the examination excludes a urinary tract infection, then further diagnostics is carried out in the form of a chest x-ray to rule out pneumonia. In this case, the indication is fever with no apparent source for more than 5 days, or cough for more than 10 days, or persistent high fever (> 40), or leukocytosis without any other cause. For example, mycoplasma pneumonia can cause high fever for one to three weeks. Also, a sign of latent pneumonia may be a respiratory rate that exceeds the expected value at an elevated temperature.

If the cause of the fever is unknown, a blood culture may be done to check for bacteremia. Children under 28 days of age are recommended for a complete septic examination, including lumbar puncture, as they are at the highest risk of developing latent dangerous infections. They do blood tests and cultures, urinalysis and cultures, lumbar puncture (cell count, protein, glucose, culture, Gram stain and culture, virus testing).

To help doctors narrow down the causes of your child’s fever, consider the following questions and possible sources of fever:

1. Are there animals at home? (salmonellosis from reptiles and psittacosis from birds)
2. Has anyone in the family experienced something like this after trips to the Mediterranean? Is there something similar in the family? (familial Mediterranean fever)
3. Does your child have a heart murmur? (bacterial endocarditis)
4. Has your child been around farm or wild animals? (brucellosis, tularemia)
5. Was your child bitten by a tick? (Lyme disease, Q fever)
6. Was your child scratched by a kitten? (cat-scratch disease)
7. Did they take any medication? (drug fever)
8. Has your child eaten any raw or undercooked foods, or drank unpasteurized milk or juice?
9. Has your child had similar episodes before and was it associated with mouth ulcers? (Marshall Syndrome)
10. Has your child missed any routine vaccinations? (Your doctor may not think about vaccine-preventable diseases, believing that your child should be vaccinated and protected from them. )
11. Has your child recently left the country? (malaria or other infectious diseases)
12. In addition to fever, did they have other symptoms such as night sweats and weight loss? (lymphoma)

What drugs can reduce fever?

Children should be treated for fever equal to or greater than 39°C. Children between 6 months and 5 years of age may develop seizures due to high fever (called febrile seizures). If your child does have a febrile seizure, there is a chance that the seizures will recur, but as a rule, children will outgrow the febrile seizures. Febrile seizures do not mean your child has epilepsy.

Research indicates that ibuprofen may be a better choice than acetaminophen for pain and fever in children compared to acetaminophen. It is recommended to use no more than 3 doses of ibuprofen 10 mg/kg per day or 4 doses of 15 mg/kg acetaminophen per day. At the same time, the child should drink water to reduce the risk of drug toxicity. Some experts suggest prescribing antipyretics for fever only once a day to avoid potential complications when taken as scheduled, such as liver complications in children treated with acetaminophen every 4 hours, and kidney complications in children treated with ibuprofen every 6 hours.

Aspirin and the risk of Reye’s syndrome in children

Do not give your child aspirin without first talking to their doctor. Aspirin use in children has been linked to Reye’s syndrome, a potentially serious or fatal condition. Therefore, pediatricians do not recommend the use of aspirin (or any medication containing aspirin) to treat any viral illness in children.

Other ways to reduce temperature

Dress your child lightly. Excess clothing will trap body heat and cause a rise in temperature.

Encourage your child to drink plenty of fluids such as juices, sodas, punch or popsicles.

Give your child a warm bath.

Place cold washcloths on areas of the body where blood vessels are close to the surface of the skin, such as the forehead, wrists and groin.

When to call a doctor with a temperature?

Call your child’s doctor right away if your child is less than 2 months old and any of the following conditions are present:

• Fever over 40ºC
• Your baby is crying inconsolably
• Your baby is hard to wake up
• Your baby’s neck is stiff
• Your baby has cramps
• Any purple spots are present on the skin
• Breathing is difficult and does not improve after you clear your nose
• your child cannot swallow anything and is salivating
• your child looks very sick (if possible, check your child’s appearance one hour after taking the appropriate dose of acetaminophen)

Call your child’s doctor within 24 hours if your child is 2 to 4 months old and has any of the following conditions:

• Fever greater than 40°C (especially if your child is younger than 2 years old)
• Burning when urinating or pain
• Your child has had a fever for more than 24 hours with no apparent cause or infection.
• Your child has a fever for more than 72 hours
• The fever went away for more than 24 hours and then came back

Your child has a history of febrile seizures.

Call a doctor at home
To make an appointment with a doctor
or call +7 (812) 331-17-74

Cryptocurrency fever. Bitcoin futures soared 25% on the first day of trading

December 11, 2017

• Technologies

• Alexander Baulin

  Author

Photo by REUTERS / Dado Ruvic On Friday, December 8, for the first time in a week, the bitcoin rate stopped rising and fell from $18,000 by more than 20%. However, after the start of futures trading on the CBOE exchange, its rate began to rise again

On Friday, Bitcoin stopped its crazy December rally. Since the beginning of the month, when bitcoin was worth about $10,000, its rate rose to $18,200 on Friday, December 8th. This was followed by a collapse to $13,300 per unit of cryptocurrency on Sunday, December 10, but by Monday morning, the rate recovered and reached $16,600. This is evidenced by data from the Coinmarketcap portal.

The rapid growth of the rate took place against the backdrop of the preparation of the CBOE exchange for the first official trading in bitcoin futures. The media indicate that one of the reasons for the growth was the demand for cryptocurrency from exchanges planning to launch bitcoin trading – they planned to insure customers in case of sharp jumps in the cryptocurrency rate.

• Earn on bitcoin. Three steps to creating a trading strategy on the crypto market

After the start of trading in futures, participants in cryptocurrency exchanges apparently decided to take profits. The volume of transactions on cryptocurrency platforms reached a record $29billion, there were long delays in the passage of payments – more than 24 hours – in total, about 200,000 transactions “hung” according to the bitcoin.com resource.

The start of trading in futures on the CBOE exchange returned the participants confidence in bitcoin, as one of the traders put it, he “watched the biggest increase in the history of trading.” The bitcoin exchange rate dipped a little, and then grew by 21%, trading was interrupted twice due to the rapid growth of the cryptocurrency (by 10% and 20%).