Pediatric Graves’ Disease: Controversies in Management

Rivkees, Scott A.

doi:10.1159/000320028

Cited by 93 publications

(81 citation statements)

References 111 publications

(96 reference statements)

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“…In children, the incidence of Graves' disease is about 1:10,000 [2]. Graves' hyperthyroidism is an autoimmune disorder; secretion of thyroidstimulating immunoglobulin that binds to and triggers the Gprotein-coupled thyroid-stimulating hormone (TSH) receptor results in diffuse enlargement of the thyroid gland.…”

Section: Hyperthyroidismmentioning

confidence: 99%

Ocular Manifestations of Pediatric Systemic Disease

Lim

2016

Hanyang Med Rev

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An ocular manifestation of a systemic disease is an ocular condition that directly or indirectly results from a pathologic process from another part of the body. Ocular manifestations can occur in various systemic diseases in pediatrics. However, ocular manifestations are difficult to recognize especially in pediatric diseases because most clinicians ignore ocular involvement of systemic diseases. Ocular manifestations can be the first findings of systemic disease in some pediatric disease, and numerous ocular manifestations can be associated with amblyopia, which is a disorder of sight. Therefore we must be able to recognize the ocular manifestations for diagnosis and management of pediatric systemic diseases.Although we cannot deal with ocular manifestations of all pediatric systemic disease in this paper, we have reviewed particular diseases that are may be of interest to the general physician and pediatric ophthalmologists. This paper aims to review the ocular manifestations of various pediatric diseases. HYPERTHYROIDISMHyperthyroidism is caused by over secretion of thyroid hormone; during childhood, it is caused by Graves' hyperthyroidism, the most common cause of pediatric hyperthyroidism [1]. In children, the incidence of Graves' disease is about 1:10,000 [2]. Graves' hyperthyroidism is an autoimmune disorder; secretion of thyroidstimulating immunoglobulin that binds to and triggers the Gprotein-coupled thyroid-stimulating hormone (TSH) receptor results in diffuse enlargement of the thyroid gland. Other etiologies of hyperthyroidism include gain-of-function germline mutations in the TSH receptor, which are detected in both familial and sporadic cases of non-autoimmune hyperthyroidism. These subjects, whose disease can occur in the infantile period or in later childhood, have a hyperplastic thyroid gland with goiter and decreased levels of TSH.Childhood onset Graves' ophthalmopathy is uncommon and occurs mostly in girls. Pediatric diseases are important because diagnosis and care for these can be complex. Among them, specific diseases have been associated with ocular involvement. This review presents the ocular manifestations of various pediatric diseases relevant to the clinician. An array of ocular manifestations of hyperthyroidism, hypoparathyroidism, diabetes mellitus, porphyria, cystinosis, mucopolysaccharidosis, Wilson disease, juvenile idiopathic arthritis, systemic lupus erythematosus, Marfan syndrome, Weill-Marchesani syndrome are describ ed. In this review we will review ocular manifestations of systemic pediatric diseases for comprehensive understanding of eye involvement. With this review, authors can recognize the ocular manifestations for diagnosis and management of pediatric systemic diseases.

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Section: Hyperthyroidismmentioning

confidence: 99%

Ocular Manifestations of Pediatric Systemic Disease

Lim

2016

Hanyang Med Rev

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“…The optimal treatment of hyperthyroidism in children and adolescents remains a matter of debate [16][17][18]. Most patients are initially treated with ATD.…”

Section: Introductionmentioning

confidence: 99%

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Azizi

Amouzegar

2018

Journal of Pediatric Endocrinology and Metabolism

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Background: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. Methods: Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. Results: In 304 patients (245 females and 59 males), the mean age was 15.6 ± 2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7 ± 2.4 years. The mean MMI dose was 4.6 ± 12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. Conclusions: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

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“…Radiation therapy used to treat cancers of the head and neck can cause problems with the thyroid gland. 15 Indications for screening at risk patients include history of thyroid dysfunction or prior thyroid surgery, age >30 years, symptoms of thyroid dysfunction or the presence of goiter, thyroid peroxidase antibody (TPOAb) positivity, type 1 diabetes or other autoimmune disorders, history of miscarriage or preterm delivery (RPL), history of head or neck irradiation, family history of thyroid dysfunction, morbid obesity (BMI ≥40 kg/m2), use of amiodarone or lithium, recent administration of iodinated radiologic contrast, history of infertility and residing in an area of known moderate-to-severe iodine insufficiency. 16 There was no consensus on cut off value of TSH during pregnancy till 2010 and majority of the clinicians were not treating subclinical hypothyroidism.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of feto-maternal outcome in clinical and subclinical hypothyroidism

Gupta

Pandotra

Jindal

et al. 2017

Int J Reprod Contracept Obstet Gynecol

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Background: Thyroid diseases are the one of commonest endocrine disorders affecting women of reproductive age group, and hence constitute the commonest endocrine disorder complicating pregnancy. Maternal thyroid function changes during pregnancy and inadequate adaptation to these changes results in thyroid dysfunction. The objective of this study was to determine the prevalence of clinical and subclinical hypothyroidism and to study the fetal and maternal complications associated with hypothyroidism.Methods: A prospective and observational study undertaken over a period of 2 years from 1st October 2009 onwards. Pregnant women were screened for thyroid dysfunction irrespective of gestational age. Patients were divided into two group; Group I (subclinical hypothyroidism)- all pregnant patients with serum TSH ≥ 3 mu/l up to 6 mu/l and normal free T4 levels. Group II (clinical hypothyroidism)- all pregnant patients with serum TSH level ≥ 6 mu/l OR on thyroxine pre-pregnancy.Results: In the present study, prevalence of thyroid disorder was 6.22%, subclinical hypothyroidism and clinical hypothyroidism being 3.77% and 2.45% respectively. In subclinical group and clinical group, we found, preeclampsia, preterm labour, first trimester abortions and oligohydramnios in 13.75% versus 19.23%, 13.75% versus 36.54%, 11.25% versus 11.53%, and 16.25% versus 23.02% respectively. Subclinical hypothyroidism was more prevalent and hidden leading to the poor obstetrical outcome and fetal complications like low birth weight, prematurity and intrauterine growth restriction. There was higher incidence of caesarean deliveries in both groups more in clinical hypothyroid cases.Conclusions: Due to the adverse effect of maternal thyroid disorder on maternal and fetal outcome, timely diagnosis and initiation of treatment of hypothyroid disorders is essential.

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Pediatric Graves’ Disease: Controversies in Management

Cited by 93 publications

References 111 publications

Ocular Manifestations of Pediatric Systemic Disease

Ocular Manifestations of Pediatric Systemic Disease

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

Comparative study of feto-maternal outcome in clinical and subclinical hypothyroidism

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