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Diagnosis and management of hyperthyroidism from prenatal life to adolescence
Juliane Léger1, Jean Claude Carel1
1Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Robert Debré, Service d'Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du développement, F-75019, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, F-75019, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), Unité 1141, DHU PROTECT, F-75019, Paris, France.
Insights
Childhood hyperthyroidism, often Graves
Area of Science:
- Pediatric Endocrinology
- Thyroid Disorders
- Internal Medicine
Background:
- Childhood hyperthyroidism is a rare condition of excessive thyroid hormone production.
- Manifestations vary with severity, impacting metabolism, growth, and neurocognitive development.
- Graves' disease is the predominant cause in pediatric populations.
Purpose of the Study:
- To provide a comprehensive overview of diagnosing and managing hyperthyroidism in children.
- To discuss treatment strategies and their implications from fetal development through adolescence.
- To highlight special considerations for pregnant women and neonatal cases.
Main Methods:
- Review of current literature and clinical guidelines for pediatric hyperthyroidism.
- Analysis of treatment modalities including antithyroid drugs, radioactive iodine, and thyroidectomy.
- Discussion of diagnostic approaches and management strategies across different pediatric age groups.
Main Results:
- Antithyroid drugs offer a chance for remission in 40-50% of cases after prolonged treatment.
- Radioactive iodine and thyroidectomy require lifelong levothyroxine replacement.
- Fetal and neonatal hyperthyroidism, though rare, are serious and require careful management.
Conclusions:
- Effective management of pediatric hyperthyroidism is crucial for normal development.
- Treatment choice depends on disease severity, patient age, and potential for remission.
- A multidisciplinary approach is essential for optimal outcomes in children with hyperthyroidism.
Abstract:
Hyperthyroidism in children is a rare heterogeneous syndrome characterized by excessive thyroid hormone production. Its manifestations differ according to disease severity. For all forms of hyperthyroidism, treatment aims to restore a euthyroid state, enabling the child to demonstrate appropriate metabolism, growth, and neurocognitive development. Graves' disease is the most frequent cause of hyperthyroidism in children. Treatment modalities include antithyroid drugs, with the advantage that prolonged treatment for several years can be followed by freedom from medical intervention in about 40-50% of cases. It may also be treated with radioactive iodine or, less frequently, thyroidectomy, these more radical treatments both necessitating subsequent lifelong levothyroxine treatment. Particular care is required in the management of pregnant women with Graves' disease. Fetal and neonatal forms of hyperthyroidism are transient and rare, but nevertheless serious. Here, we provide an overview of the best approach to hyperthyroidism diagnosis and management, from fetal development to adolescence.
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