Graves’ disease in children in the two decades following implementation of an iodine prophylaxis programme

Abstract

Grave’s disease (GD) is a form of thyroid autoimmune disease characterised by hyperthyroidism. It is a rare clinical problem in paediatrics. Development of disease is the result of genetic susceptibility and some environmental factors. One of the best-documented environmental factors involved in thyroid autoimmunity is iodine excess. The aim of our study was to analyse the clinical course and response to pharmacological treatment in children diagnosed with Graves’ disease in first two decades after mandatory salt iodination. Records of 94 children diagnosed with GD in the years 1998-2017 were analysed. Medical data of patients was compared between two decades following implementation of iodine prophylaxis: 1998-2007 (first-decade group – FDG) and 2008-2017 (second-decade group – SDG); 34 and 60 patients, respectively. Medical data of FDG was obtained from archival records and previous analysis performed in 2006. Data of 60 patients from SDG were obtained from currently available medical records. Results were statistically analysed using Microsoft Excel and Statistica 11 software. Results: In our study, after mandatory salt iodination, the tendency of an increase in newly diagnosed GD in children without family susceptibility was observed. The antibody profile indicates the significant contribution of the autoimmune process involving all thyroid antigens; therefore, the term “autoimmune hyperthyroidism” seems to be more appropriate than classical GD in this group of patients. The first-choice treatment with methimazole rarely causes adverse events during the therapy, and they have benign character.

Transient Hyperthyrotropinemia in Outpatient Children with Acute Infections of the Respiratory System

“…It is also important for, normal growth and metabolic processes in children [1,2]. The prevalence of thyroid disease in Polish children is not very well known, but in the first two decades after mandatory salt iodination, we observed a lower incidence of goiter and a higher frequency of Graves disease [3,4]. In the iodine-sufficient regions, the most common cause of acquired primary hypothyroidism (characterized by low free T4 (FT4) and elevated thyroid stimulating hormone (TSH) serum concentrations) is autoimmune hypothyroidism (Hashimoto's thyroiditis); its prevalence in childhood has been estimated as 1-2% [1].…”

Thyroid Surgery in Children and Adolescents: A 10-year Retrospective Study at a Single Institution

“…Propylthiouracil (PTU) should not be prescribed in pediatric patients due to reports of PTU-induced ANCA-positive vasculitis and rapidly progressive PTU liver failure with a low chance of reversibility. ( 11 ) Radioactive iodine therapy is a safe and reliable treatment but with a high risk of future hypothyroidism and thyroid cancer development or gonadal damage consequent to radiation exposure, and its use as initial therapy is therefore decreasing. ( 12 ) Surgical treatment for Graves’ disease is indicated in children with large goiters complicating thyroid cancer if they do not wish to receive treatment with antithyroid drugs and prefer achieving remission sooner, or if they cannot use antithyroid drugs.…”

Definitive treatment of Graves’ disease in children and adolescents

“…Down syndrome, Turner syndrome, or Di George syndrome, as well as in families with a history of autoimmune thyroid disorders. There are also some environmental factors regarded as potentially associated with increased risk of GD in the paediatric population: iodine excess (mandatory salt iodination), infectious diseases, selenium status, dioxins, or radiation exposure [5][6][7][8][9][10].…”