Clinical Features And Follow-Up Results Of Children With Hyperthroidism

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.