Diagnosis and Management of Juvenile Hyperthyroidism in Germany: A Retrospective Multicenter Study

Abstract

This retrospective multicenter study was designed to survey the management of childhood and adolescent hyperthyroidism in six pediatric endocrinological units in Germany. Fifty-six patients aged between 1.1 and 17.0 yr (median 10.5 yr) were enrolled. Data were collected retrospectively from the patients' records by a trained pediatric endocrinologist using standardized questionnaires. After the diagnosis of hyperthyroidism was established on the basis of clinical and biological findings, treatment with antithyroid drugs (carbimazole, methimazole, thiamazole, propylthiouracil) was started in all patients. In 55/56 of the patients treated with antithyroid drugs, euthyroidism was achieved (98%). However, 26 patients (47%) were still hyperthyroid after discontinuation of the medication. Eight children with continued hyperthyroidism ultimately underwent subtotal thyroidectomy 13-136 (median 28) months after the initial diagnosis. Management principles of the participating centers were heterogeneous. As a consequence, prospective multicenter studies are urgently needed to establish clear standards for the diagnosis and therapy of childhood hyperthyroidism.

Treatment of paediatric hyperthyroidism but not hypothyroidism has a significant effect on weight

“…Perhaps hyperthyroid patients start the day with more energy but due to their tachycardia and increased metabolic rate, they tire more quickly by the end of the day. Such a hypothesis is supported by the restlessness and hyperactivity described by others 12,17. Alternatively, their difficulty falling asleep at night (which many of our subjects reported, and which has been described in other studies13,16) may contribute to their feeling of tiring more quickly.…”

“…It is curious that the same question regarding energy levels received about 65% positive response in both the hyperthyroid and hypothyroid patients, even though one might expect that hyperthyroid patients would report increased energy levels. Fatigue or tiring more quickly has not been reported in other studies of hyperthyroid children 12,13,16,17. Perhaps hyperthyroid patients start the day with more energy but due to their tachycardia and increased metabolic rate, they tire more quickly by the end of the day.…”

Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016

“…According to the ATA guidelines (19), the suggested starting dose of MMI is 0.2–0.5 mg/kg/d, and MMI should be used within a range of 0.1–1.0 mg/kg/d (27, 44, 50, 69,70,71,72). Specifically, the suggested doses are 1.25 mg/d for infants, 2.5–5.0 mg/d for children aged 1–5 yr, 5–10 mg/d for children aged 5–10 yr, and 10–20 mg/d (i.e., the adult dose) for children and adolescents aged 10–18 yr. For severe cases, the dose can be increased to as high as twice the above-listed amounts.…”

Verlauf, Therapie und Komorbidität bei Hashimoto-Thyreoiditis im Kindesalter

“…In der Studie wurden Patienten von 4 spezialisierten Zentren in Bayern erfasst.Die Diagnose Hashimoto-Thyreoiditis wurOriginalien J. Dötsch 1 · M. Hau 1 · P. Heidemann 2 · W. Rabl 3 Die Schilddrüsenstoffwechsellage wurde biochemisch definiert.Eine Hyperthyreose wurde beim Vorliegen eines supprimierten TSH-(<0,5 mU/l) und eines T4-oder fT4-Werts oberhalb der 95. Perzentile definiert.…”

“…Dies deckt sich mit der in Deutschland ausgeübten Vorgehensweise bei Hyperthyreose im Allgemeinen [3].Jedoch ist zu bedenken, dass sich die Hyperthyreose bei Hashimoto-Thyreoiditis prinzipiell von dem Verlauf bei der Hyperthyreose des Morbus Basedow unterscheidet: Während bei der HashimotoThyreoiditis die Hyperthyreose in der Regel eine spontanen Remission unter symptomatischer thyreostatischer Therapie erlebt,neigt die Hyperthyreose beim Mor-…”