Endocrine Abstracts

Introduction: Juvenile thyrotoxicosis is treated with anti-thyroid drugs using a block and replace or dose titration regimen. There is a high rate of relapse and majority require definitive treatment with surgical or radio-iodine ablation. Increasingly radio-iodine therapy is being used in children, particularly in the USA, but experience with this is limited in the UK. In our unit we have an experienced paediatric thyroid surgeon and we have always carried out surgery in children who relapse after medical treatment.

Objectives: To review presentation, management and outcome of juvenile thyrotoxicosis at a single tertiary centre.

Methods: Case notes review of all children aged 0–18 years diagnosed with thyrotoxicosis between January 2000–December 2010.

Results: Twelve eligible patients were identified. This gives an incidence of 0.7/100 000 per year. Figures may be higher due to difficulties in ascertainment. All patients were female aged 10–18 years, with a median peak at 14.4 years and presented with classical symptoms of thyrotoxicosis.

All patients were treated with carbimazole. The block and replace regimen was used in 83.3% and dose titration in 16.6%. Total duration of treatment varied from 9 months to 5 years.

Of the 12 patients, 6 (54.5%) proceeded directly to surgery due to goiter or difficult symptom control; medical treatment was discontinued in 5 (45.5%) patients of whom 3 (60%) relapsed and 2 (40%) remained in remission at 1and 2 years of follow up. All three relapsed patients underwent surgery. One patient remains on medical treatment after 5 years

Conclusion: Our findings are consistent with figures reported in the literature. In view of the high relapse rate and the developing experience of radio-iodine ablation definitive treatment may need to be considered earlier in our group of children.