Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland

Abstract

SummaryObjective To measure the UK and Ireland incidence of childhood (<15 years) thyrotoxicosis and to describe the presenting features.Context Incidence data on thyrotoxicosis in childhood are not available for the UK and Ireland. Recent studies have reported an apparent increase in cases in Europe. Design A national prospective surveillance study for 12 months from September 2004, co-ordinated by The British Paediatric Surveillance Unit (BPSU). Patients and measurements All paediatricians across the UK and Ireland were requested monthly to report new cases. Details of presenting features were then obtained by questionnaire. Results One hundred ten cases of acquired childhood thyrotoxicosis were identified in the UK and Ireland. The incidence of acquired thyrotoxicosis was 0AE9 per 100,000 <15 years olds in the UK and Ireland, (95% CI: 0AE8-1AE1). Autoimmune thyrotoxicosis accounted for 96% of cases. There was an increasing incidence with age in each sex. Females have a significantly higher incidence than males in the 10-to 14-year age group. A variety of presenting symptoms were reported: weight loss (64%), fatigue/tiredness (54%), change in behaviour' (50%) and heat intolerance (47%). 4.5 % cases were asymptomatic. The commonest signs were goitre (78%) and tremor (58%). There were no cases of thyroid storm. Conclusions This national population survey defines the incidence of thyrotoxicosis in children in the UK and Ireland during 2004-2005, which was lower than expected in comparison with other European studies. The survey illustrates contemporary presenting characteristics of the disease.

Outcomes of Children with Hashitoxicosis

“…Another peculiarity of our investigation is that Htx patients were selected on the basis of the absence of TRABs, which are generally accepted to be one of GD hallmarks [7,8]. In spite of the selective criteria adopted for diagnosis of Htx, our results confirm the wide clinical and biochemical variability of Htx and the potential pitfalls that may be encountered in the diagnosis of some cases with features overlapping between Htx and GD [3,4]. …”

“…The transient hyperthyroid phase of Hashimoto's thyroiditis is known as hashitoxicosis (Htx), and is believed to result from unregulated release of stored thyroid hormones during inflammatory-mediated destruction of the thyroid gland [2]. Htx has been reported as the second commonest cause of thyrotoxicosis in childhood, after Graves' disease (GD) [3]. Presenting signs and symptoms of Htx can be very similar to those generally observed in GD, as previously reported in a retrospective study on clinical presentation of Htx in 8 children [4].…”

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

“…It may occur at any age during childhood, but its frequency increases with age, peaking during adolescence. The incidence of GD is thought to have risen over the last few decades (2,3). The estimated prevalence of GD varies between countries, from 1/10 000 person-years in the United States to 1/100 000 personyears (for children aged 0-15 years) in the UK and Ireland (2).…”

“…The incidence of GD is thought to have risen over the last few decades (2,3). The estimated prevalence of GD varies between countries, from 1/10 000 person-years in the United States to 1/100 000 personyears (for children aged 0-15 years) in the UK and Ireland (2). A frequency of up to 14 per 100 000 person-years has been reported in Hong Kong, and differences in the frequency of this condition do not seem to depend on dietary iodine intake (4,5).…”

Should radioiodine be the first-line treatment for paediatric Graves’ disease?

“…The incidence of acquired thyrotoxicosis in the United Kingdom and Ireland for children under 15 years of age is around 0.9 per 100,000; of which Graves' disease is the most common type (1). Peak incidence occurs in 10-to 15-yearolds with a marked female predominance.…”