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Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland: the case for long-term antithyroid treatment and the importance of initial counselling
  1. Mariam Kourime1,
  2. Sheena McGowan2,
  3. Mabrouka Al Towati2,
  4. S Faisal Ahmed2,
  5. Graham Stewart3,
  6. Scott Williamson4,
  7. Iain Hunter5,
  8. Malcolm D C Donaldson2
  1. 1 University Hospital Abderrahim Harouchi, Casablanca, Morocco
  2. 2 Child Health Section, Glasgow University School of Medicine, Royal Hospital for Sick Children, Glasgow, UK
  3. 3 Royal Alexandra Hospital, Paisley, Scotland, UK
  4. 4 Crosshouse Hospital, Ayrshire, Scotland, UK
  5. 5 Wishaw General Hospital, Lanarkshire, Scotland, UK
  1. Correspondence to Dr Malcolm D C Donaldson, Child Health Section of University of Glasgow School of Medicine, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK; malcolm.donaldson{at}glasgow.ac.uk

Abstract

Background Thyrotoxicosis is both rarer and more severe in children than in adults, rendering management difficult and often unsatisfactory.

Objective To ascertain outcome in a geographically defined area of Scotland between 1989 and 2014.

Method Retrospective case note review with follow-up questionnaire to family doctors for patients with Graves’ disease and Hashimoto’s thyroiditis.

Results Sixty-six patients (58 females:8 males) comprising 53 with Graves’ disease and 13 with Hashimoto’s thyroiditis were diagnosed at median 10.4 (2.9–15.8) years and followed up for 11.8 (2.6–30.2) years. Antithyroid drug (ATD) therapy was stopped electively in 35 patients after 4.5 (1.5–8.6) years, resulting in remission in 10/13 Hashimoto’s thyroiditis and 10/22 Graves’ disease. Side effects occurred in 12 patients receiving carbimazole, six of whom changed to propylthiouracil; no adverse events occurred in the latter patients.

Second-line therapy was given to 37 patients (34 with Graves’ disease), comprising radioiodine (22) at 15.6 (9.3–24.4) years for relapse (6), poor control/adherence (14) or electively (2); and surgery (16) at 12 (6.4–21.3) years for relapse (4), poor control/adherence (5) and electively (7). Adherence problems with thyroxine replacement were reported in 10/33 patients in adulthood.

Conclusions Hashimoto’s thyroiditis should be distinguished from Graves’ disease at diagnosis since the prognosis for remission is better. Remission rates for Graves’ disease are low (10/53 patients), time to remission variable and adherence with both ATD and thyroxine replacement often problematic. We recommend (a) the giving of long-term ATD rather than a fixed course of treatment in GD and (b) meticulous and realistic counselling of families from the time of diagnosis onwards.

  • Endocrinology
  • Pharmacology

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Footnotes

  • Contributors Data for the study were collected by MK, MAT and SMcG, with help from the consultants caring for the patients: GS, SW and SFA. MDCD and MK devised the patient questionnaire and collated the results. MK carried out the analysis of data and wrote the paper with MDCD. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval The research and development departments of National Health Service (NHS) Glasgow & Clyde, Ayrshire & Arran and Lanarkshire were informed of and approved the study. NHS Lanarkshire requested and obtained Caldicott Guardian approval. The study was registered as a quality improvement project with NHS Greater Glasgow and Clyde Clinical Governance unit.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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