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Remission in children with hyperthyroidism treated with propylthiouracil. Long-term results
Insights
Propylthiouracil effectively treats hyperthyroid children, but relapses are common. Monitoring triiodothyronine levels, not just thyroxine (T4), is crucial for optimal treatment duration and preventing premature cessation.
Area of Science:
- Pediatric Endocrinology
- Pharmacology
Background:
- Hyperthyroidism in children requires effective treatment.
- Propylthiouracil (PTU) is a common therapeutic agent.
Purpose of the Study:
- To evaluate the efficacy and relapse rates of propylthiouracil in treating hyperthyroid children.
- To determine factors influencing remission and relapse.
- To assess the normalization patterns of thyroid hormone levels during treatment.
Main Methods:
- Prospective study of 69 hyperthyroid children treated with propylthiouracil.
- Surveillance of 53 patients, monitoring thyroid hormone levels (thyroxine and triiodothyronine) and remission status.
- Analysis of relapse rates and duration of remission.
Main Results:
- Initial remission was achieved in 64% of patients, with a 47% relapse rate.
- At follow-up, 45% of patients remained in remission with a mean duration of 55 months.
- Triiodothyronine levels normalized significantly slower than thyroxine (T4) levels.
- No correlation found between treatment response and goiter size or initial hormone levels.
- Adverse reactions occurred in six patients, two of which were serious.
Conclusions:
- Propylthiouracil treatment can lead to remission in hyperthyroid children, but relapses are frequent.
- Monitoring triiodothyronine normalization is essential to avoid premature treatment discontinuation based solely on thyroxine levels.
- The high relapse rate may be influenced by the timing of treatment cessation relative to hormone level normalization.
Abstract:
We treated 69 hyperthyroid children with propylthiouracil, of whom 53 remained under surveillance. Of these children, 34 (64%) had an initial remission, but relapses were frequent (47%). At this writing, 24 patients (45%) were in remission, with a mean duration of remission of 55 months (range, ten to 132 months). We found that the triiodothyronine level took significantly longer than the thyroxine (T4) level to return to normal. Thus, based on the T4 level alone, treatment may have been stopped prematurely in some patients, causing the relapse rate to be falsely high. The response to therapy did not depend on the size of the goiter nor on the initial levels of T4 or triiodothyronine. Six patients had adverse reactions, which were serious in two patients.