Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland: the case for long-term antithyroid treatment and the importance of initial counselling

Kourime, Mariam; McGowan, Sheena; Towati, Mabrouka Al; Ahmed, S Faisal; Stewart, Graham; Williamson, Scott; Hunter, Iain Andrew; Donaldson, Malcolm

doi:10.1136/archdischild-2017-313454

Cited by 19 publications

(33 citation statements)

References 26 publications

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“…The second frequent cause of juvenile thyrotoxicosis is hashitoxicosis and its prevalence was reported as 0.5% to 22% in different studies (9). Like as results reported in a recent study from Scotland and 19.6% of patients with thyrotoxicosis classified as hashitoxicosis in that cohort (20). The distinction of GD and hashitoxicosis may be difficult as seen in this study, the most common reported presenting complaints among patients with GD and hashitoxicosis are similar.…”

Section: Resultssupporting

confidence: 78%

“…Very few studies continue in this respect and some completed studies have shown conflicting results (11)(12)(13). Remission is reported approximately in one third of children with GD and subsequently relapse occurs in half of patients after achieved remission (7,(14)(15)(16)(17)(18)(19)(20)(21). Remission rates are lower and relapse rates are higher in children than in adults (22).…”

Section: Introductionsmentioning

confidence: 99%

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Management of thyrotoxicosis in children and adolescence: a Turkish multi-center experience

Esen¹,

Bayramoğlu²,

Yildiz³

et al. 2018

Jcrpe

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Objective: To determine demographic and biochemical features of childhood and juvenile thyrotoxicosis and determine the treatment outcomes in them. Methods: We reviewed records of 503 children from in 12 different cities of Turkey who were diagnosed with thyrotoxicosis between 2007 to 2017. Results: In all, 375 (74.6%) patients had been diagnosed with Graves' disease (GD) and 75 (14.9%) had hashitoxicosis, and 53 (10.5%) had been diagnosed with uncommon causes of thyrotoxicosis. Commonest presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitation, weight loss and excessive sweating. The cumulative remission rate was 17.6% in 370 patients with GD who received ATDs for initial treatment, and were treated for a median of 22.8 months (range 0.3-127 months). No variables predictive of the achievement of remission were identified. Twenty-seven patients with GD received secondline treatment for poor disease control and adverse events associated with antithyroid drugs. Total thyroidectomy was reported in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Ten patients received radioiodine; six became hypothyroid, 1 remained hyperthyroid and started taking antithyroid drug again; 1 achieved remission and 2 unknown progresses due to lost up follow up. Conclusion: This study demonstrated that using anti-thyroid drugs with the hope that the patients will enter a remission over time is generally accepted first-line approach in Turkish children and adolescents with GD, however, this approach achieved low remission rate which was consistent with previous studies

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Section: Resultssupporting

confidence: 78%

Section: Introductionsmentioning

confidence: 99%

Management of thyrotoxicosis in children and adolescence: a Turkish multi-center experience

Esen¹,

Bayramoğlu²,

Yildiz³

et al. 2018

Jcrpe

View full text Add to dashboard Cite

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“…This proportion is slightly higher than the proportion (43%) found in a recent Scottish study [35]. In that study, radioactive iodine treatment was given much more frequently than in our study.…”

Section: Discussioncontrasting

confidence: 54%

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

et al. 2019

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Background: We found an increase in the incidence rate (IR) of childhood thyrotoxicosis (CT) during the 1990s in central Sweden. The optimal treatment method for CT is a subject that is still debated upon. Objectives: To investigate whether the increase in IR of CT in Sweden persists and to study the treatment outcome. Method: Children <16 years of age diagnosed with CT during 2000–2009 and living in 1 of 5 counties in central Sweden were identified retrospectively using hospital registers. Data on clinical and biochemical characteristics and outcomes of treatment were collected from medical records. The corresponding data from 1990 to 1999 were pooled with the new data. Results: In total, 113 children were diagnosed with CT during 1990–2009 in the study area. The overall IR was 2.2/100,000 person-years (95% CI 1.2–2.5/100,000 person-years). The IR was significantly higher during 2000–2009 than during 1990–1999 (2.8/100,000 [2.2–3.6] vs. 1.6/100,000 person-years [1.2–2.2], p = 0.006). The increase was significant for both sexes. Seventy percent of the patients who completed the planned initial treatment with antithyroid drugs (ATDs) and were not lost to follow-up relapsed within 3 years. Boys tended to relapse earlier than girls (6.0 months after drug withdrawal [95% CI 1.9–10.0] vs. 12.0 months [95% CI 6.8–17.3], p = 0.074). Conclusions: The IR of CT is increasing in both girls and boys. Relapse rate after withdrawal of ATD treatment is 70%. Boys tend to relapse earlier than girls, and this needs to be further investigated.

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“…Some clinicians believe that hypothyroidism is preferable to hyperthyroidism, because it is easier to treat and has a less serious morbidity [29]. However, medical adherence is problematic not only for long-term ATD therapy but also for the thyroxine supplement after hypothyroidism induced by definite therapy [30, 31]. Further long-term, prospective studies are required to determine the optimal duration of ATD treatment for pediatric GD.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcomes of Pediatric Graves Disease Patients Treated with Anti-Thyroid Drugs: Experience from a Taiwan Medical Center

Chiang¹,

Ting

Huang

et al. 2019

Preprint

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2 Graves disease (GD) is the most common cause of thyrotoxicosis in children and 3 adolescents, accounting for 15% of all thyroid diseases during childhood.4 Anti-thyroid drugs (ATD) are recommended as the first-line treatment in children and 5 adolescents. However, the remission rate is lower in children than in adults, and the 6 optimal treatment duration and favorite factors associated with remission remain 7 unknown. We aimed to investigate long-term outcomes of pediatric GD patients 8 receiving ATD. We retrospectively reviewed medical charts of 300 pediatric GD 9 subjects, who were initially treated with ATD and followed up for more than one year, 10 from 1985 to 2017 at MacKay Children's Hospital. The 300 patients comprised 257 11 (85.7%) females and 43 (14.3%) males, median age at diagnosis was 11.6 (range 12 2.7-17.8) years, and median follow-up period was 4.7 (range 1.1-23.9) years. Overall, 13 122 patients achieved the criteria for discontinuing ATD treatment, seventy-nine 14 (39.9%) patients achieved remission, with a median follow-up period of 5.3 (range 15 1.5-20.1) years. Patients in the remission group were more likely to be aged < 5 years 16 (remission vs. relapse vs. ongoing ATD; 11.4 vs. 0 vs. 2.6%, P=0.02), less likely to 17 have a family history of thyroid disease (24.1 vs. 42.1 vs. 52.6 %, P=0.001), and had 4 18 lower TRAb levels (42.8 vs. 53.6 vs. 65.1 %, P=0.02). Conclusion: Long-term ATD 19 remains an effective treatment option for GD in children and adolescents. Pediatric 20 GD patients aged < 5 years, having no family history of thyroid disease and having 21 lower TRAb levels were more likely to achieve remission. 5 22 Introduction 23 Graves disease (GD) is a common disorder in adults, with a prevalence of 24 approximately 0.5-1%. Pediatric patients account for < 5% of the total number of GD 25 patients [1]. However, GD remains the most frequent cause of thyrotoxicosis in 26 children and adolescents, accounting for 15% of thyroid disease during childhood [2].27 The incidence increases gradually from young children and peaks in adolescents [3].28 The optimal treatment option for GD in children and adolescents remains 29 controversial. Current treatment approaches for GD include anti-thyroid drugs (ATD), 30 radioactive iodine and surgery. ATD is usually recommended as the first-line 31 treatment for GD in children and adolescents. However, the remission rate is lower in 32 children than in adults [2, 4, 5]; the optimal treatment duration and the favorite factors 33 associated with remission have not yet been established in children and adolescents 34 [6-8]. 35The issue of how long ATD should be used in pediatric GD is important and 36 warrants further study [5, 9]. In adult GD patients, if remission does not occur after 37 12-18 months of ATD therapy, the chance of remission with prolonged therapy is 38 very low [4, 10]. In the pediatric population, longer treatment duration is associated 6 39 with a higher remission rate. Lipple reported that the median time to remission with 40 ATD was 4...

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Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland: the case for long-term antithyroid treatment and the importance of initial counselling

Cited by 19 publications

References 26 publications

Management of thyrotoxicosis in children and adolescence: a Turkish multi-center experience

Management of thyrotoxicosis in children and adolescence: a Turkish multi-center experience

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

Long-Term Outcomes of Pediatric Graves Disease Patients Treated with Anti-Thyroid Drugs: Experience from a Taiwan Medical Center

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