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G445 Thyrotoxicosis: An audit of presentation, management and treatment outcome in a single centre
  1. G Ormerod1,
  2. N Bridges2,
  3. S Alexander2
  1. 1Faculty of Medicine, Imperial College London, London, UK
  2. 2Department of Paediatric Endocrinology and Diabetes, Chelsea and Westminster Hospital, London, UK

Abstract

Aims Thyrotoxicosis is less common in children than adults and remits less often. We audited the presentation, management and outcome of thyrotoxicosis in a single paediatric endocrinology clinic.

Subjectsand Methods Clinical records were retrospectively audited for children with a diagnosis of thyrotoxicosis who were managed in the paediatric endocrine clinic between 01/01/2002 and 31/12/2014.

Results 19 children with a diagnosis of thyrotoxicosis were identified. The majority were girls (68%). 10/19 (51%) were of white British or any other white background. Mean age at diagnosis was 12.3 years (range: 3–16years). Commonest presenting complaints were weight loss in 11/19 (58%), fatigue (32%), palpitations (26%), tachycardia (26%), increased appetite (21%) and tremor (21%). Goitre was noted in 12/19 (63%), all reported at ultrasound as consistent with Graves disease or thyroiditis. Technetium uptake scan was undertaken in one patient and showed diffuse intense tracer uptake, consistent with Graves disease. Anti-TSH Receptor and anti-TPO antibodies were tested in 18/19 cases and were positive in 68% and 81% respectively. All patients were commenced on a titrating regimen of Carbimazole. 6/19 (32%) were prescribed Propranolol for symptomatic control. One patient, aged 12 at diagnosis, was switched to PTU due to a reaction to Carbimazole. “Block and replace” regimen was used in 5/19 (26%), starting on average 14.5 months (range: 6–31 months) after diagnosis. 7/15 (46%) for whom the data outcome is clear have had a trial off treatment at an average of 20.5 months after diagnosis (range: 4–40 months). Common reasons for not planning a trial off treatment were poor adherence with treatment or difficult-to-control disease. 5/7 (71.4%) subsequently relapsed and two went on to have definitive treatment. Many of our patients remain on long-term drug treatment ranging from 2–9 years.

Conclusion Weight loss and fatigue were the commonest presenting features of paediatric thyrotoxicosis. Remission rates were lower (~20–30%) in the paediatric population than in adults. Many children opt for long-term anti-thyroid drugs rather than definitive treatment.

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