title: Atrial flutter: an uncommon pediatric manifestation of hyperthyroidism.
abstract: OBJECTIVE
  Atrial 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.
  
  
  METHODS
  We 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.
  
  
  CONCLUSIONS
  When 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.
authors.affiliation: Divisions of Cardiology and Endocrinology, Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
authors.forename: W A
authors.initials: WA
authors.lastname: Suarez
authors.forename: G F
authors.initials: GF
authors.lastname: Van Hare
authors.forename: I D
authors.initials: ID
authors.lastname: Wexler
authors.forename: J E
authors.initials: JE
authors.lastname: Arnold
mesh_terms: D000241:Adenosine; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology*; D002675:Child, Preschool; D004562:Electrocardiography; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications* / Q000175:diagnosis
chemical_list: D000241:Adenosine