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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