Endocrine Abstracts

Thyrotoxicosis is uncommon in young people with a UK incidence around 1/100 000 (<15 years). Most cases of persistent thyroid hormone excess are due to Graves’ disease although transient episodes are seen in Hashimoto’s thyroiditis. Thyroid peroxidase antibodies can frequently be identified in both forms of autoimmune thyroid disease with antibodies to the TSH receptor more typical of Graves’. Patients with Graves’ are usually managed initially with the anti-thyroid drug (ATD) carbimazole using a dose titration (DT) regimen or a block and replace (BR) approach. Propylthiouracil should generally be avoided in the young because of the risk of hepatic dysfunction. There is an association between ATD exposure and likelihood of remission in paediatric practice although to what extent this is an effect of the medication on the autoimmune process, the impact of establishing a euthyroid state or the natural history of the disease is unclear. Unfortunately Graves’ disease tends to be more severe in the young with low remission rates following ATD therapy. Side-effects of ATD are also more common in this age group and the recent American Thyroid Association guidelines suggest that the BR regimen in children should ‘in general be avoided’. However this recommendation was not based on studies conducted in young people and the potential for greater biochemical stability with the BR approach means that this strategy may be the preferred option in some patients. Recent data has shown that radioiodine therapy as a ‘definitive’ treatment for Graves’ is being used more frequently in the UK although a lengthy period of ATD administration is still used in some parts of Europe. Surgery (total thyroidectomy) remains an important therapeutic option. Although management options need to be tailored to the individual many patients will ultimately be rendered hypothyroid and require long term thyroxine replacement.