Treatment of Thyrotoxicosis in Children With Thiourea Derivatives

Abstract

The 5 successfully treated patients (Cases 1, 5, 6, 7 and 8) were treated for 13, 12, 7, 15 and 6 mo. and are in remission for 4 yr., 12 mo, 14 mo., 7 mo. and 3 yr., respectively. The 4 patients operated upon (Cases 2, 3, 4 and 9) were treated for 5, 26, 6 and 3 mo., respectively. Case 3 had a remission for 5½ mo. after 24 mo. of continuous medical treatment, relapsed and became refractory to the drug during 2 mo. of additional treatment. (See table 2.) In 3 of the 5 successful cases (Cases 5, 6 and 7), BMR returned to normal within 10 to 14 days after initiation of treatment. In 1 case (Case 8), BMR fell to normal after 18 days and in the other (Case 1) after 28 days. In 2 of the unsuccessfully treated cases (Cases 2 and 3), BMR fell to normal after 31 and 271 days, respectively. The BMR of 2 cases (Cases 4 and 9) failed to return to normal. (Table 3.) Relapses occurred from 1 to 3 times in 5 cases. Three patients were in the successfully treated group (Cases 1, 6 and 7) and 2 in the operated group (Cases 2 and 3). These relapses apparently resulted [See Table 4 in Source Pdf.] from thyroid given in an attempt to reduce the size of the gland (Case 1); insufficient treatment due to shortage of the drug (Case 1); too rapid reduction of the therapeutic dose (Cases 2 and 6); severe acute upper respiratory infections: 1 after the patient had been in a remission for 8 mo. without therapy (Case 1) and 2 while the patients were on maintenance therapy (Cases 3 and 7); and emotional shock (Case 3). (Table 2.) Subtotal thyroidectomy was performed on 4 patients because of: (1) markedly enlarged thyroid (Case 2), (2) refractoriness to the drug during treatment following a third relapse (Case 3), (3) slow response, psychotic episodes and cardiac complications (Case 4) and (4) poor cooperation, patient unmanageable (Case 9). In the group operated upon, 3 of the 4 subsequently developed endocrine disturbances. One became moderately hypothyroid and retarded in growh (Case 2), 1 mildly hypothyroid (Case 3) and 1 moderately hypothyroid and markedly obese (Case 9). Up to the present time all have required continuous treatment with dessicated thyroid gland to correct the hypothyroidism. One patient has a severe keloid scar (Case 9). (Table 4.) The blood counts showed no significant changes. Usually there was a mild to moderate reduction in the granulocytes with a relative increase in the lymphocytes. A mild eosinophilia was observed in 2 cases. There were no changes in the erythrocyte counts or hemoglobin that could be attributed to drug therapy. No hemorrhagic tendencies developed and there was no clinical evidence of jaundice in any of the patients. At no time has there been any evidence of hypothyroidism in any of the 5 patients who are in remission following medical treatment. Nine children with thyrotoxicosis whose ages ranged from 5 to 15 years have been treated with thiourea derivatives during the past six years. Four subsequently underwent subtotal thyroidectomy. Three of the four developed endocrine complications, viz., hypothyroidism and retarded growth, mild hypothyroidism, and hypothyroidism and marked obesity. At the present time, 5 patients are in remission for periods of from 7 months to 4 years. From 1 to 3 relapses occurred in 5 patients who experienced remissions. Up to the present time, only one of these has undergone thyroidectomy. No untoward symptoms resulted from the drugs used in any of the patients. The advantages of prolonged medical treatment of thyrotoxicosis in children is discussed.