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

Abstract

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