Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Abstract

Background: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. Methods: Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. Results: In 304 patients (245 females and 59 males), the mean age was 15.6 ± 2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7 ± 2.4 years. The mean MMI dose was 4.6 ± 12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. Conclusions: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

Long-Term Outcomes of Pediatric Graves Disease Patients Treated with Anti-Thyroid Drugs: Experience from a Taiwan Medical Center

“…However, the median time to remission reported in the literature was highly variable, and the optimal duration of ATD has not yet been determined. Our treatment protocol resulted in 40% of remission which is consisted with previous studies [12, 28], after a median of 5.3 years of ATD treatment. As shown in our study, long-term medical therapy resulted in high rates of lost follow up.…”

Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience

“…Graves’ ophthalmopathy is an inflammatory disease of the eye and orbital tissues, and its prevalence has been previously reported to range from 17.1-67.6% in children and adolescents with GD (21,27). A relatively high prevalence (86.8%) of eye signs in children with GD was reported in a recent study (20).…”

“…Thus, there was no patient who received PTU as initial treatment in this patient group. Despite the presence of various definitions of remission and a wide variety of ATD treatment durations from two years and beyond, remission rates after ATD withdrawal are reported to vary from 11% to 49% (7,19,21,22,29). In the present study, remission was achieved in 58.0% of patients at the time when their anti-thyroid treatment was ceased for possible remission.…”

“…In this study we found that this method had been used slightly more frequently than radioiodine ablation. Various studies reported that hypothyroidism occurs in nearly all children who undergo total thyroidectomy (20,21,33,34). Our observations were concordant with these studies.…”

“…Remission has been reported in approximately one third of children with GD and relapse occured in half of the patients after remission was achieved (7,14,15,16,17,18,19,20,21). Remission rates are lower and relapse rates are higher in children than in adults (22).…”