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Diagnosis and treatment of thyrotoxicosis in childhood. A European questionnaire study
H Perrild1, A Grüters-Kieslich, U Feldt-Rasmussen
1Department of Medicine B, Bispebjerg University Hospital, Copenhagen, Denmark.
Insights
Pediatric thyrotoxicosis diagnosis and treatment practices show consensus on thyroid hormone tests and antithyroid drugs for Graves
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Clinical Practice Guidelines
Background:
- Thyrotoxicosis in children presents unique diagnostic and therapeutic challenges.
- European pediatric endocrinology practices for thyrotoxicosis were not well-documented.
Purpose of the Study:
- To survey current diagnostic and treatment strategies for pediatric thyrotoxicosis among European specialists.
- To identify consensus and variations in clinical approaches.
Main Methods:
- A questionnaire was distributed to 672 European Thyroid Association (ETA) and European Society for Pediatric Endocrinology (ESPE) members.
- Responses from 99 individuals/groups across 22 countries were analyzed.
Main Results:
- Consensus exists on using total thyroxine (T4) and/or free T4, and thyrotropin for diagnosis.
- Antithyroid drugs (ATD) are the primary treatment for Graves' disease, with carbimazole/methimazole most common.
- Thyroid imaging (ultrasound) and antibody testing (thyroglobulin, TSH receptor, microsomal) are frequently employed.
Conclusions:
- Established diagnostic protocols for pediatric thyrotoxicosis are widely adopted.
- Antithyroid drug therapy is the mainstay for Graves' disease, often combined with T4 for long-term management.
- Surgery is preferred for specific conditions like adenomas and recurrent goiter.
Abstract:
A covering letter and a questionnaire covering the diagnosis and treatment of thyrotoxicosis in childhood was circulated between October 1992 and February 1993 amongst 672 European members of the European Thyroid Association (ETA) and members of the European Society for Pediatric Endocrinology (ESPE). Almost 50% replied to the letter and 99 individuals or groups from 22 countries completed the questionnaire. A consensus was reached on the use of total thyroxine (T4) and/or free T4 and thyrotropin as routine diagnostic tools. Two-thirds included total triiodothyronine (T3) and/or free T3 and 32% used a thyrotropin-releasing hormone test. Surprisingly, thyroglobulin autoantibodies were used as a routine test by 78%; 63% included thyrotropin receptor antibodies and 60% microsomal antibodies, whereas only 50% measured thyroperoxidase antibodies. For thyroid imaging, 40% performed a thyroid scintigram and 56% measured the size of the thyroid gland by ultrasound. Antithyroid drugs (ATD) were the basic initial treatment of choice given by 99% of the respondents for children with uncomplicated Graves' disease. Carbimazole, methimazole and thiamazole were the most frequently used drugs, with a median initial dose of 0.8 mg.kg-1.day-1. Two-thirds added beta-blockers and a few used sedatives. The ATD dose was adjusted for each patient by 39%, whereas 56% combined ATD with T4 for long-term treatment; 84% gave treatment for a fixed period (44% for 1-2 years). Surgery was considered the treatment of choice in children with an adenoma (83%), with a nodular (53%) or large goiter (16%) and recurrence after ATD (14%).(ABSTRACT TRUNCATED AT 250 WORDS)