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Clinical Features And Follow-Up Results Of Children With Hyperthroidism

Year 2022, Volume 44, Issue 3, 239 - 246, 01.10.2022
https://doi.org/10.7197/cmj.1115567

Abstract

Objective: Hyperthyroidism is a rare clinical condition in childhood that can cause serious problems. Information on the epidemiological features, follow-up and treatment of pediatric patients with hyperthyroidism is quite limited. In this study, clinical and laboratory findings and follow-up results of children with hyperthyroidism are presented.
Materials and Methods: The data of children with hyperthyroidism between 2005-2022 at Atatürk University and Erzurum Health Sciences University Pediatric Endocrinology clinics were retrospectively analyzed.
Results: 43 (81.1%) female and 10 (18.9%) male patients aged 2-18 years (14.05±3.0) were included in the study. Of the patients, 36 (67.9%) had Graves' disease (GD), 14 (26.4%) had Hashimoto's thyroiditis (HT), 2 (3.8%) had subacute thyroiditis, and 1 (1.9%) had hyperactive thyroid nodules. The most common symptoms were palpitations (75.5%), sweating (60.4%), tremors in the hands (49.1%), heat intolerance (45.3%) and weight loss (32.1%). Mean SD values of height, body weight and body mass index at the time of diagnosis were -0.05±1.16, -0.67±1.20 and -0.77±1.25, respectively. Goitre and exophthalmos were present in 69.8% and 30.2% of the cases, respectively. At the time of diagnosis, mean serum thyroid stimulating hormone (TSH), free tri-iodothyronine, free tetra-iodothyronine, thyroglobulin, anti-thyroid peroxidase, anti-thyroglobulin and TSH receptor antibody levels were 0.03±0.09 mIU/L, 13.0.34±7.07 pg/ml, 3.30±1.70 ng/dl, 101.93±180.35 ng/ml, 600.30±858.58 IU/ml, 322.82±644.08 IU/ml, and 12.41 ±14.37 IU/L, respectively. 42 (79.2%) patients were treated with propranolol and methimazole, 3 (5.7%) patients were treated with propranolol and propylthiouracil, and 4 (7.5%) patients were treated with propranolol, while 4 (7.5%) patients were untreated. The mean duration of treatment was 14.67±17.51 months. The mean time to euthyroid state antithyroid drug (ATD) was 24.80±14.33 days. While no serious drug-related side effects were detected in any patient, urticaria rash developed in 1 (1.9%) patient in the 1st month of treatment. Total thyroidectomy was performed in 3 cases with GD and 1 case with hyperactive thyroid nodules. Radioactive iodine treatment was not given to any of the cases. The remission rate in patients with GD was 46.7% at the early stage of treatment and 16.7% during the entire follow-up. The recurrence rate was 71.4%. At the last visit, 15 (28.3%) patients were euthyroid, 1 (1.9%) hyperthyroid, and 5 (9.4%) hypothyroid. While 21 (39.6%) of the cases were still using antithyroid medication, 11 (20.8%) were excluded from follow-up.
Conclusion: The first and second most common causes of hyperthyroidism in children and adolescents are GH and HT, respectively. TRAb positivity, thyroid scintigraphy findings and clinical follow-up may be useful in distinguishing between GH and HT. ATD therapy is effective and safe in keeping GH in remission.

References

  • KAYNAKLAR 1-Léger J, Carel JC. Diagnosis and management of hyperthyroidism from prenatal life to adolescence. Best Pract Res Clin Endocrinol Metab. 2018 Aug;32(4):373-86
  • 2-Léger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol. 2013;5 Suppl 1(Suppl 1):50-6.
  • 3-Binay Ç, Şimşek E. Çocuk ve Adolesanlarda Hashimoto Tiroiditi. Osmangazi Tıp Dergisi/Osmangazi Journal of Medicine, Mayıs/May, 2016;38 (2), 1-8
  • 4-Radetti G. Clinical aspects of Hashimoto's thyroiditis. Endocr Dev. 2014;26:158-70
  • 5-Król A, Czarniecka A, Jarząb B. Definitive treatment of Graves' disease in children and adolescents. Endokrynol Pol. 2021;72(6):661-5
  • 6-Esen İ, Bayramoglu E, Yıldız M et al. Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience. J Clin Res Pediatr Endocrinol 2019;11(2):164- 72
  • 7-Işık E, Alikaşifoğlu A. Çocuk ve Adölesan Yaş Grubundaki Hipertiroidili Olguların Değerlendirilmesi ve Uzun Süreli İzlemi. Ankara 2013. (https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp).
  • 8-Demir K, Konakçı E, Özkaya G et al. New features for Child Metrics: Further growth references and blood pressure calculations. J Clin Res Pediatr Endocrinol. 2020;12(2):125-9.
  • 9-Hagen-Ansert SL. The thyroid and parathyroid glands. In: Hagen-Ansert SL (Eds). Textbook of Diagnostıc Sonography. 7th ed. Missouri: Elsevier Mosby,2012; pp:588-603.
  • 10-Kaplowitz PB, Vaidyanathan P. Update on pediatric hyperthyroidism. Curr Opin Endocrinol Diabetes Obes. 2020 Feb;27(1):70-6.
  • 11-Simon M, Rigou A, Le Moal J et al. Epidemiology of childhood hyperthyroidism in france: a nationwide population-based study. J Clin Endocrinol Metabol 2018; 103:2980–7.
  • 12-Williamson S, Greene SA. Incidence of thyrotoxicosis in childhood:a national population based study in the UK and Ireland . Clin Endocrinol (Oxf) 2010;72:358–63.
  • 13-Bossowski AT, Reddy V, Perry LA et al. Clinical and endocrine features and long-term outcome of Graves’ disease in early childhood. J Endocrinol Invest 2007;30:388–92.
  • 14-Gill DS, Greening JE, Howlett TA, Levy MJ, Shenoy SD. Long-term outcome of hyperthyroidism diagnosed in childhood and adolescence: a single-centre experience. J Pediatr Endocrinol Metab. 2019 Feb 25;32(2):151-7.
  • 15-Tunç S, Köprülü Ö, Ortaç H et al. Long-term monitoring of Graves’ disease in children and adolescents: a single-center experience. Turk J Med Sci. 2019;49(2):464-71.
  • 16-Bayramoğlu E, Elmaogulları S, Sagsak E, Aycan Z. Evaluation of long-term follow-up and methimazole therapy outcomes of pediatric Graves’ disease: A single-center experience. J Pediatr Endocrinol Metab. 2019;32(4):341-6.
  • 17-Sönmez AA, Erbaş İM, Acar S et al. Evaluation of Clinical Characteristics and Treatment Outcomes of Graves’ Disease in Children and Adolescents. Trends in Pediatrics 2021;2(1):18-27
  • 18-Srinivasan S, Misra M. Hyperthyroidism in children. Pediatr Rev. 2015;36:239–48.
  • 19- Leger J, Gelwane G, Kaguelidou F, Benmerad M, Alberti C. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves’ disease: national long-term cohort study. J Clin Endocrinol Metab 2012; 97:110–9
  • 20-Azizi F, Amouzegar A. Management of thyrotoxicosis in children and adolescents; 35 years of experience in 304 patients. J Pediatr Endocrinol Metab. 2018; 31:159–65.
  • 21- Léger J, Carel JC. Management of endocrine disease: arguments for the prolonged use of antithyroid drugs in children with Graves’ disease. Eur J Endocrinol 2017;177:R59–67. .

Year 2022, Volume 44, Issue 3, 239 - 246, 01.10.2022
https://doi.org/10.7197/cmj.1115567

Abstract

References

  • KAYNAKLAR 1-Léger J, Carel JC. Diagnosis and management of hyperthyroidism from prenatal life to adolescence. Best Pract Res Clin Endocrinol Metab. 2018 Aug;32(4):373-86
  • 2-Léger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol. 2013;5 Suppl 1(Suppl 1):50-6.
  • 3-Binay Ç, Şimşek E. Çocuk ve Adolesanlarda Hashimoto Tiroiditi. Osmangazi Tıp Dergisi/Osmangazi Journal of Medicine, Mayıs/May, 2016;38 (2), 1-8
  • 4-Radetti G. Clinical aspects of Hashimoto's thyroiditis. Endocr Dev. 2014;26:158-70
  • 5-Król A, Czarniecka A, Jarząb B. Definitive treatment of Graves' disease in children and adolescents. Endokrynol Pol. 2021;72(6):661-5
  • 6-Esen İ, Bayramoglu E, Yıldız M et al. Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience. J Clin Res Pediatr Endocrinol 2019;11(2):164- 72
  • 7-Işık E, Alikaşifoğlu A. Çocuk ve Adölesan Yaş Grubundaki Hipertiroidili Olguların Değerlendirilmesi ve Uzun Süreli İzlemi. Ankara 2013. (https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp).
  • 8-Demir K, Konakçı E, Özkaya G et al. New features for Child Metrics: Further growth references and blood pressure calculations. J Clin Res Pediatr Endocrinol. 2020;12(2):125-9.
  • 9-Hagen-Ansert SL. The thyroid and parathyroid glands. In: Hagen-Ansert SL (Eds). Textbook of Diagnostıc Sonography. 7th ed. Missouri: Elsevier Mosby,2012; pp:588-603.
  • 10-Kaplowitz PB, Vaidyanathan P. Update on pediatric hyperthyroidism. Curr Opin Endocrinol Diabetes Obes. 2020 Feb;27(1):70-6.
  • 11-Simon M, Rigou A, Le Moal J et al. Epidemiology of childhood hyperthyroidism in france: a nationwide population-based study. J Clin Endocrinol Metabol 2018; 103:2980–7.
  • 12-Williamson S, Greene SA. Incidence of thyrotoxicosis in childhood:a national population based study in the UK and Ireland . Clin Endocrinol (Oxf) 2010;72:358–63.
  • 13-Bossowski AT, Reddy V, Perry LA et al. Clinical and endocrine features and long-term outcome of Graves’ disease in early childhood. J Endocrinol Invest 2007;30:388–92.
  • 14-Gill DS, Greening JE, Howlett TA, Levy MJ, Shenoy SD. Long-term outcome of hyperthyroidism diagnosed in childhood and adolescence: a single-centre experience. J Pediatr Endocrinol Metab. 2019 Feb 25;32(2):151-7.
  • 15-Tunç S, Köprülü Ö, Ortaç H et al. Long-term monitoring of Graves’ disease in children and adolescents: a single-center experience. Turk J Med Sci. 2019;49(2):464-71.
  • 16-Bayramoğlu E, Elmaogulları S, Sagsak E, Aycan Z. Evaluation of long-term follow-up and methimazole therapy outcomes of pediatric Graves’ disease: A single-center experience. J Pediatr Endocrinol Metab. 2019;32(4):341-6.
  • 17-Sönmez AA, Erbaş İM, Acar S et al. Evaluation of Clinical Characteristics and Treatment Outcomes of Graves’ Disease in Children and Adolescents. Trends in Pediatrics 2021;2(1):18-27
  • 18-Srinivasan S, Misra M. Hyperthyroidism in children. Pediatr Rev. 2015;36:239–48.
  • 19- Leger J, Gelwane G, Kaguelidou F, Benmerad M, Alberti C. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves’ disease: national long-term cohort study. J Clin Endocrinol Metab 2012; 97:110–9
  • 20-Azizi F, Amouzegar A. Management of thyrotoxicosis in children and adolescents; 35 years of experience in 304 patients. J Pediatr Endocrinol Metab. 2018; 31:159–65.
  • 21- Léger J, Carel JC. Management of endocrine disease: arguments for the prolonged use of antithyroid drugs in children with Graves’ disease. Eur J Endocrinol 2017;177:R59–67. .

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Medical Science Research Articles
Authors

Ayşe ÖZDEN> (Primary Author)
SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ERZURUM TIP FAKÜLTESİ, ERZURUM TIP PR.
0000-0002-3625-2387
Türkiye


Hakan DÖNERAY>
ATATÜRK ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-9774-3649
Türkiye

Publication Date October 1, 2022
Published in Issue Year 2022, Volume 44, Issue 3

Cite

APA Özden, A. & Döneray, H. (2022). Clinical Features And Follow-Up Results Of Children With Hyperthroidism . Cumhuriyet Medical Journal , 44 (3) , 239-246 . DOI: 10.7197/cmj.1115567