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J Clin Res Pediatr Endocrinol. 2019 May 28;11(2):164-172. doi: 10.4274/jcrpe.galenos.2018.2018.0210. Epub 2018 Nov 29.

Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience

Author information

1
Fırat University Faculty of Medicine, Department of Pediatric Endocrinology, Elazığ, Turkey
2
Dr. Sami Ulus Maternity and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
3
Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
4
Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
5
İstanbul University İstanbul Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
6
Düzce University Faculty of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
7
Adana City Hospital, Clinic of Pediatric Endocrinology, Adana, Turkey
8
Dicle University Faculty of Medicine, Department of Pediatric Endocrinology, Diyarbakır, Turkey
9
Göztepe Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
10
İstanbul University Cerrahpaşa Faculty of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
11
Erzurum Bölge Training and Research Hospital, Clinic of Pediatric Endocrinology, Erzurum, Turkey
12
Çukurova University Faculty of Medicine, Department of Pediatric Endocrinology, Adana, Turkey
13
Derince Training and Research Hospital, Clinic of Pediatric Endocrinology, Kocaeli, Turkey
14
Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
15
Konya Training and Research Hospital, Clinic of Pediatric Endocrinology, Konya, Turkey
16
Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
17
Gülhane Training and Research Hospital, Clinic of Pediatric Endocrinology, Ankara, Turkey
18
Çorlu State Hospital, Clinic of Pediatric Endocrinology, Tekirdağ, Turkey
19
Bağcılar Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
20
Diyarbakır Pediatric Hospital, Clinic of Pediatric Endocrinology, Diyarbakır, Turkey
21
Gaziantep University Faculty of Medicine, Department of Pediatric Endocrinology, Gaziantep, Turkey
22
Gaziosmanpaşa Taksim Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey

Abstract

Objective:

To determine the demographic and biochemical features of childhood and juvenile thyrotoxicosis and treatment outcome.

Methods:

We reviewed the records of children from 22 centers in Turkey who were diagnosed with thyrotoxicosis between 2007 to 2017.

Results:

A total of 503 children had been diagnosed with thyrotoxicosis at the centers during the study period. Of these, 375 (74.6%) had been diagnosed with Graves’ disease (GD), 75 (14.9%) with hashitoxicosis and 53 (10.5%) with other less common causes of thyrotoxicosis. The most common presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitations, weight loss and excessive sweating. The cumulative remission rate was 17.6% in 370 patients with GD who had received anti-thyroid drugs (ATDs) for initial treatment. The median (range) treatment period was 22.8 (0.3-127) months. No variables predictive of achieving remission were identified. Twenty-seven received second-line treatment because of poor disease control and/or adverse events associated with ATDs. Total thyroidectomy was performed in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Ten patients received radioiodine and six became hypothyroid, one remained hyperthyroid and restarted ATDs and one patient achieved remission. Two patients were lost to follow up.

Conclusion:

This study has demonstrated that using ATDs is the generally accepted first-line approach and there seems to be low remission rate with ATDs in pediatric GD patients in Turkey.

KEYWORDS:

Graves’ disease; hashitoxicosis; thyrotoxicosis; antithyroid drug; radioactive iodine; total thyroidectomy

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