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Thyrotoxicosis in children: thirty years' experience
J Raza1, P C Hindmarsh, C G Brook
1London Centre for Paediatric Endocrinology, Great Ormond Street Hospital, United Kingdom.
Insights
Antithyroid drugs (ATD) are the preferred first-line treatment for pediatric thyrotoxicosis, with block-replacement regimens offering greater convenience. Surgery is safe in specialized centers, but radioactive iodine (I131) use requires caution in young children.
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Internal Medicine
Background:
- Optimal management of pediatric thyrotoxicosis is debated.
- Antithyroid drug (ATD) therapy is a common treatment modality.
Purpose of the Study:
- To review management practices and outcomes for pediatric thyrotoxicosis.
- To evaluate the effectiveness of different therapeutic interventions.
Main Methods:
- Retrospective review of 76 pediatric patients treated between 1965 and 1995.
- Analysis of antithyroid drug (ATD) therapy, surgery, and radioactive iodine (I131) outcomes.
Main Results:
- Long-term remission achieved in 38% of patients on ATD alone after a mean of 3.3 years.
- Block-replacement ATD regimens were significantly more convenient than titration (3.4 vs. 6.1 hospital visits/year).
- Surgery resulted in hypothyroidism in 24 of 27 patients; I131 was successful in six patients.
Conclusions:
- Antithyroid drug (ATD) therapy should remain the first-line treatment for pediatric thyrotoxicosis.
- Block-replacement regimens offer improved convenience for ATD therapy.
- Surgery in specialized centers is low-risk, and I131 use requires caution in young children.
Abstract:
Optimal treatment for thyrotoxicosis remains controversial in adults, but more so in paediatric practice. We have conducted a retrospective review of the records of 76 paediatric patients seen between 1965 and 1995 to determine management practice and outcome of therapeutic interventions. Seventeen are currently on antithyroid drug (ATD) treatment, while four have had their care transferred. Of the remaining 55, 21 (38%) achieved long-term remission with ATD alone following a mean treatment duration of 3.3 y (range 0.5-7 y). Block-replacement (high dose of ATD with thyroxine replacement) was more convenient than the titration regimen (3.4+/-0.3 visits to hospital per year versus 6.1+/-0.4, p<0.001). Surgery (subtotal/total thyroidectomy) was carried out in 27 patients, of whom 24 subsequently became hypothyroid and were treated with thyroxine. I131 was used successfully in six patients, two following surgery. ATD should remain the first-line therapy; a block-replacement regimen is more convenient. Surgery in a specialized centre carries a low risk. Caution should still be exercised in the use of I131 in young children.