Endocrine Abstracts

Background: Hyperthyroidism is a significant medical condition in paediatric patients with serious health consequences. Optimal treatment remains debatable.

Objective: To review 23 years’ experience of paediatric hyperthyroidism in the West of Scotland.

Methods: Case notes of patients treated for thyrotoxicosis in Glasgow, Paisley, Ayrshire and Lanarkshire from 1987 until 2009 inclusive were retrospectively reviewed. Patients with Down’s (3) and Di George (1) syndrome, neonatal Graves’ disease (3), toxic nodular goitre (2), and Hashimoto’s encephalopathy were excluded.

Results: Fifty-six patients were identified of whom 45 (40 F:5 M) were eligible for analysis. Median (range) age at diagnosis was 9.8 (1.5–14.7) years, 37 had Graves’ disease (GD) and 8 Hashimoto’s. Antithyroid drugs (ATDs) [Carbimazole 44, PTU 1] were used initially in all patients (28 dose titration, 17 block and replace), with 3 changing to PTU because of Carbimazole intolerance. Thirteen patients remain on ATDs, 7 for <3 years, 6 for 3–12 years. Sixteen (36%) patients entered remission after stopping medical treatment, 7 within 3 years and 9 after 3.3–11.5 years. Of these, 6 subsequently relapsed and were given ATD±radioiodine treatment. Four patients were treated electively; 3 with surgery (2 relapsed) and one with radioiodine (also relapsed). Twelve patients did not remit after 3.7 (1.3–8) years and were given second line treatment because of unsatisfactory control/compliance problems/side effects – 6 radioiodine (2 euthyroid, 4 hypothyroid with subsequent compliance problems in 2); 6 sub-total thyroidectomy (4 euthyroid, 1 hypothyroid, 1 relapsed).

Conclusion: Only 10/45 (22%) patients experienced sustained remission after stopping ATDs (7/10 requiring >3 years medical treatment) while second line treatment was not always optimal. A care plan for each patient should be devised in consultation with the family, and should consider age, social situation and educational stage.