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Hyperthyroidism in children: an Indian experience
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Pediatric hyperthyroidism, primarily Graves
Area of Science:
- Pediatric Endocrinology
- Internal Medicine
- Clinical Research
Background:
- Hyperthyroidism in children is uncommon and predominantly caused by Graves' disease.
- Pediatric Graves' disease presents with distinct clinical features compared to adults.
Purpose of the Study:
- To analyze the clinical characteristics and management outcomes of pediatric hyperthyroidism.
- To highlight the unique presentation and treatment challenges in children with Graves' disease.
Main Methods:
- Retrospective review of 24 children diagnosed with hyperthyroidism between 1986-1993.
- Evaluation of clinical presentation, laboratory findings, treatment with carbimazole, and patient response.
Main Results:
- Graves' disease was diagnosed in 20 children, with neuropsychiatric symptoms being the most common initial presentation (90%).
- 85% of patients had eye involvement, and 30% had cardiac involvement.
- Carbimazole therapy was effective in 17 out of 20 patients, but 6 relapsed upon withdrawal.
Conclusions:
- Pediatric hyperthyroidism, mainly Graves' disease, requires prolonged medical therapy for sustained remission.
- Neuropsychiatric symptoms and insidious onset are key differentiators from adult-onset disease.
Abstract:
During the period 1986-1993, 24 children with hyperthyroidism were referred to us for management. Two of them had factitious hyperthyroidism, one toxic nodular goiter and another neonatal Graves' disease. Twenty children (6M, 14F) had Graves' disease. Their age at presentation was 10.86 +/- 2.02 years and duration of symptoms ranged from 2.5 months to 7 years. Neuropsychiatric manifestations, such as hyperkinesis, irritability, excitability and behavioral problems, were the most common initial presenting symptoms (90%). Goiter of varying grades was present in 18 children. Eye involvement of mild or moderate intensity was present in 85% and cardiac involvement in 30%. Serum free thyroxine and triiodothyronine levels were high and radioactive iodine uptake was elevated. All of them received carbimazole 0.5-0.7 mg/kg in three divided doses. Seventeen responded to therapy over a period of time while three did not. On withdrawal, six of the responders relapsed. Hyperthyroidism in children is rare and when it occurs it is almost always due to Graves' disease. The prominence of neuropsychiatric symptoms, insidious onset and absence of severe infiltrative ophthalmopathy differentiates it from the adult type of disease. Prolonged medical therapy is needed to induce good continued remission.