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Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients
L Lazar1, O Kalter-Leibovici, A Pertzelan
1Institute for Endocrinology and Diabetes, Schnieder Children's Medical Center of Israel, Petah Tiqva.
The Journal of Clinical Endocrinology and Metabolism
|November 4, 2000
Summary
Prepubertal children with Graves' thyrotoxicosis present atypically and experience a more severe disease course. Early definitive treatment may be beneficial due to higher adverse reactions to antithyroid drugs and lower remission rates in this group.
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Graves' Disease
Background:
- Graves' thyrotoxicosis is a common cause of hyperthyroidism in children.
- Disease presentation and treatment outcomes can vary based on pubertal status.
Purpose of the Study:
- To compare the clinical presentation, treatment response, and outcomes of Graves' thyrotoxicosis in prepubertal, pubertal, and postpubertal children.
- To evaluate the suitability of antithyroid drug (ATD) therapy in different pediatric age groups.
Main Methods:
- Retrospective analysis of 7 prepubertal, 21 pubertal, and 12 postpubertal children diagnosed with Graves' thyrotoxicosis.
- Comparison of clinical symptoms, growth parameters, bone maturation, thyroid hormone levels (T3), adverse reactions to ATDs, and remission rates across the three groups.
Main Results:
- Prepubertal children exhibited atypical symptoms (weight loss, frequent bowel movements) and significantly higher height and bone age acceleration compared to older groups.
- Higher rates of adverse reactions to ATDs (71%) were observed in prepubertal children, with two experiencing major reactions.
- Remission rates were similar across groups, but time to remission was longer in prepubertal children, and overall remission was low (28%).
Conclusions:
- Graves' thyrotoxicosis presents atypically and follows a more severe course in prepubertal children.
- Antithyroid drug therapy is associated with higher adverse reactions and lower remission rates in this younger group.
- Earlier consideration of definitive treatment, such as radioactive iodine or surgery, is recommended for prepubertal children with Graves' thyrotoxicosis.