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Diagnosis and management of juvenile hyperthyroidism in Germany: a retrospective multicenter study
J Dötsch1, T Siebler, B P Hauffa
1Department of Pediatrics, University of Erlangen-Nürnberg, Germany. JoergWDoetsch@yahoo.com
Insights
Pediatric hyperthyroidism management varied across German centers. While antithyroid drugs achieved euthyroidism in most children, nearly half relapsed after treatment cessation, necessitating further study for standardized care.
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Internal Medicine
Background:
- Childhood and adolescent hyperthyroidism requires effective management strategies.
- Current treatment protocols exhibit heterogeneity across pediatric endocrinology units.
Purpose of the Study:
- To survey the management of pediatric hyperthyroidism in German pediatric endocrinology units.
- To identify variations in diagnostic and therapeutic approaches.
- To highlight the need for standardized care guidelines.
Main Methods:
- Retrospective multicenter study involving six pediatric endocrinology units in Germany.
- Data collected from 56 patients (aged 1.1-17.0 years) using standardized questionnaires.
- Analysis of treatment with antithyroid drugs (carbimazole, methimazole, thiamazole, propylthiouracil).
Main Results:
- Euthyroidism was achieved in 98% of patients treated with antithyroid drugs.
- However, 47% of patients remained hyperthyroid after medication discontinuation.
- Eight children required subtotal thyroidectomy due to persistent hyperthyroidism.
Conclusions:
- Antithyroid drug therapy is effective in achieving initial euthyroidism for pediatric hyperthyroidism.
- High relapse rates after discontinuation indicate a need for optimized long-term management.
- Heterogeneous management principles underscore the urgency for prospective multicenter studies to establish clear diagnostic and therapeutic standards.
Abstract:
This retrospective multicenter study was designed to survey the management of childhood and adolescent hyperthyroidism in six pediatric endocrinological units in Germany. Fifty-six patients aged between 1.1 and 17.0 yr (median 10.5 yr) were enrolled. Data were collected retrospectively from the patients' records by a trained pediatric endocrinologist using standardized questionnaires. After the diagnosis of hyperthyroidism was established on the basis of clinical and biological findings, treatment with antithyroid drugs (carbimazole, methimazole, thiamazole, propylthiouracil) was started in all patients. In 55/56 of the patients treated with antithyroid drugs, euthyroidism was achieved (98%). However, 26 patients (47%) were still hyperthyroid after discontinuation of the medication. Eight children with continued hyperthyroidism ultimately underwent subtotal thyroidectomy 13-136 (median 28) months after the initial diagnosis. Management principles of the participating centers were heterogeneous. As a consequence, prospective multicenter studies are urgently needed to establish clear standards for the diagnosis and therapy of childhood hyperthyroidism.