Endocrine Abstracts

Introduction: Thyrotoxicosis, the commonest cause of which is Graves’ disease, is rare in childhood and adolescence.We report a consecutive series of patients referred to a single tertiary paediatric endocrine centre over 5 years.

Methods: Retrospective case note and database review of patients referred 01/2013–02/2018.

Results: 27 patients (21F) with Graves’ disease in 21, and Hashitoxicosis in 6. During the same period an additional 30 patients (29 Graves’, 1 Hashitoxicosis) were referred to the service but managed jointly at their local General Hospital. We report the characteristics of patients managed solely at our Teaching hospital. Median age at diagnosis was 13 years (Range: 7 days – 17 years). 48% of patients were Black African/Caribbean origin. The majority were referred from primary care (52%). Ophthalmopathy was present in 11, proptosis being commonest (9); all were managed conservatively. Median fT4 was 69pmol/l; fT3 26pmol/l. 59% had TSH-Receptor antibodies (TRAB) measured: 94% positive. The two patients with negative TRAB had Hashitoxicosis. 72% had Thyroid Peroxidase antibody measured, (75% positive); 52% had Thyroglobulin Antibody measured (43% positive). Patients with Hashitoxicosis did not require treatment. Graves’ patients received standard antithyroid treatment, usually 40 mg Carbimazole for a minimum 2 years initially. 17(81%) were treated with ‘block and replace’ therapy. Median time to euthyroid status was 6 weeks (range 3–20) before introduction of thyroxine 62% experienced side effects (commonest urticaria, 38%) patients. One patient developed 1st degree heart block within 48 hours of starting Atenolol, which resolved promptly with withdrawal of β-Blockade. 10 patients completed 1 course of treatment: seven patients remain in remission, 3 relapsed and restarted treatment. 9 patients presently remain on treatment. Two had care transferred to another hospital.

Conclusion: We report the profile a large Paediatric series of newly diagnosed thyrotoxicosis over the last five years from a single UK centre. The high incidence may be due to the high Afro-Carribean population in the catchment area. Ophthalmopathy was not uncommon. All patients responded to carbimazole which was generally well tolerated. Poor adherence was common. Longer term follow up of this cohort will inform us of treatment outcomes in this population.