BSPED2013 Poster Presentations (1) (89 abstracts)
Low remission rates and high failure rate for medical treatment of thyrotoxicosis in childhood and adolescence: strategic implications for stopping antithyroid drugs
Mabrouka Al-Towati 1 , Sheena McGowan 1 , Ian Hunter 2 , Scott Williamson 3 , Faisal Ahmed 1 & Malcolm Donaldson 1
1Section of Child Health, Glasgow University, UK; 2Wishaw General Hospital, Lanarkshire, UK; 3Crosshouse Hospital, Ayrshire, UK.
Background: Paediatric thyrotoxicosis due Graves’ disease (GD)and Hashimoto’s thyroiditis (HT) disease is both more rare yet more severe than in adulthood. Antithyroid drug treatment (ATD) is with carbimazole or PTU either alone (dose titration (DT)) or with L-thyroxine (L-T4) – block and replace (BR).
Methods: We have examined outcome of medical treatment in a cohort of patients treated from 1989 to 2012 according to whether medical treatment was given for <3 or >3 years.
Results: 62 patients (8 M) with either GD (50) or HT (12), median (range) age 10.8 (1.8–15.8) years at diagnosis, received initial DT (42) or BR (20) treatment with ATD. Outcome was available in 36 patients receiving ATD for median (range) 5 (3–16.2) years and in 12 patients for 2 (0.3–2.8) years. In the <3 years group, seven patients had surgery and three radioiodine (RI) for poor control, while two (one GD and one HT) remitted when ATD was stopped. In the >3 years group 20 stopped ATD for possible remission of whom ten relapsed (all GD) and ten remitted (5HT),one had surgery and 12 had RI for failed therapy while three remain on ATD after 5.5–8.3 years.
Conclusion: Paediatric thyrotoxicosis may follow a protracted course with variable age of remission and high relapse rate as well as high rate of failure with ATD. We therefore recommend that patients on BR therapy do not discontinue their medication abruptly, but instead are weaned slowly off ATD according to thyroid function tests after stopping L-T4 therapy, in the hope of anticipating incipient relapse.
Volume 33
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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