Juvenile Hyperthyroidism  

Said Azzoug , Farida Chentli
Endocrine diseases department Bab El Oued Hospital Algiers, Algeria
Author    Correspondence author
International Journal of Clinical Case Reports, 2015, Vol. 5, No. 36   doi: 10.5376/ijccr.2015.05.0036
Received: 05 Jul., 2015    Accepted: 06 Aug., 2015    Published: 08 Sep., 2015
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Preferred citation for this article:

Azzoug S. and Chentli F., 2015, Juvenile Hyperthyroidism, International Journal of Clinical Case Reports, 5(36) 1-2 (doi: 10.5376/ijccr.2015.05.0036)

Abstract

Background: Hyperthyroidism is less frequent in children than adults and its clinical profile is different.
Objective: The objective of our study was to analyze the clinical characteristics of hyperthyroidism in children and adolescents.

Subjects and Methods: It is a retrospective study concerning 161 patients (129 Females/32 Males) with mean age of 15.63 ± 3.51 years. Their medical records were reviewed.

Results: 98.1% have Graves’ disease. Appealing symptoms were thyrotoxicosis signs in 69%, ophtalmological signs in 15% and goiter in 16%. Diagnosis delay was of 20.73±20.69 months. Clinical presentation was obvious in 81% and discrete in 19%. Goiter was of type II/type III in 74% and of type I in 26%, exophtalmous was present in 69% and it was severe in 12.5%. Several complications were recorded, cardiothyreosis in 1.86%, dysglycemia in 13.04%, myopathy in 3.72% and behavioral disorders in 6.83%.

Conclusion: Graves’ disease is the main etiology of hyperthyroidism in children and adolescents; diagnosis is often delayed although it is clinically obvious so complications may occur. Therefore hyperthyroidism should be diagnosed and treated promptly.

Keywords
Juvenile hyperthyroidism; Graves’ disease; Thyrotoxicosis; Goiter

Introduction
Hyperthyroidism is less frequent in children than adults, and its clinical profile is different, the aim of our study was to analyze the clinical characteristics of hyperthyroidism in children and adolescents.

Material and Methods

It is a retrospective study concerning all patients aged twenty years or less presenting for hyperthyroidism during a period of thirty one years [1981-2012]. Their medical records were reviewed. We analyzed sex ratio, age at diagnosis, presenting symptoms, etiologies, complications and treatment modalities.

Results

161 patients were recruited. Sex ratio was of 4 Females/1 Male, mean age at diagnosis was 15.63 ± 3.51 years. Age clusters at diagnosis was as follows, less than 10 years in 6.9%, between 10 and 16 years in 48.8%, between 16 and 20 years in 44.3%. Diagnosis delay was of 20.73 ± 20.69 months. Etiologies were as follows, Graves’ disease in 98.13%, nodular goiter in 1.24% and thyroïditis in 0.63%. Appealing symptoms were thyrotoxicosis symptoms in 69%, goiter in 16% and ophtalmological signs in 15%. Clinical presentation was obvious in 81% and discrete in 19%. Goiter was of type II/type III in 74% and of type I in 26%. Exophtalmous was present in 69% and was severe in 12.5%. Complications were as follows, cardiothyreosis (heart failure) in 1.86%, dysglycemia in 13.04% (diabetes in 4.34% and prediabetes in 8.70%), myopathy in 3.72% and behavioral disorders in 6.83%. Treatment was medical using antithyroid drugs in 68.94%, surgery in 26.1%, radioiodine treatment in 3.1% and surgery plus radioiodine treatment in 1.86%.

Discussion

Thyrotoxicosis is rare in children with a frequency of 0.1-3/100 000 person-years (Lavard, 1994). The majority of patients are diagnosed during puberty as was in our study where the mean age at diagnosis was 15.63 ± 3.51 years. As in adults, hyperthyroidism predominates in females. Diagnosis is often delayed (Shulman, 1997), in our study, diagnosis delay was of 20.73 ± 20.69 months. Prepubertal children present for weight loss or frequent stools whereas pubertal children present for classical signs of thyrotoxicosis as heat intolerance, irritability, palpitations or for goiter (Lazar, 2000). As for Lazar (2000) all our patients had palpable goiters, it was small in 26% and medium to large in 74%. Graves’ disease is the cause of around 95% of hyperthyroidism in children (Birrell, 2002). Ophtalmopathy is reported in 25-63% (Chan, 2002), it was observed in 69% of our patients. The delayed diagnosis reported earlier may account for the severity of hyperthyroidism in children as complications were observed in almost one fourth of our patients. Remission of Graves’ disease is rare in children occurring in less than one third of patients after several years of medical treatment (Bauer, 2011), so many patients may require definitive treatment either surgery or radioiodine treatment.

Conclusion

Hyperthyroidism is rare in children and adolescents as only 161 cases were recruited during thirty one years. Although clinical presentation is obvious, diagnosis is often delayed, which may explain the possible occurrence of complications even in young patients. Graves’ disease is the main etiology. Relapsing of Graves’ disease is frequent in children after antithyroid drug withdrawal, so many patients require definitive treatment.

References

Bauer A.J., 2011, Approach to the pediatric patient with Graves’ disease: when is definitive therapy warranted? J. Clin. Endocrinol. Metab., 96: 580-588
 http://dx.doi.org/10.1210/jc.2010-0898

Birrell G., and Cheetham T., 2004, Juvenile thyrotoxicosis; can we do better? Arch. Dis. Child., 89: 745-750
http://dx.doi.org/10.1136/adc.2003.035980 

Chan W., Wong G.W., Fan D.S., et al., 2002, Ophthalmopathy in childhood Graves’ disease, Br. J. Ophthalmol., 86: 740-742
http://dx.doi.org/10.1136/bjo.86.7.740

Lavard L., Ranlov R., Perrild H., et al., 1994, Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988, A nationwide study, Eur. J. Endocrinol.,130: 565-568
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Lazar L., Kalter-Leibovici O., Pertzelan A., et al., 2000, Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients, J. Clin. Endocrinol. Metab., 85: 3678-3682
http://dx.doi.org/10.1210/jcem.85.10.6922

Shulman D.I., Muhar I., Jorgensen E.V., et al., 1997, Autoimmmune hyperthyroidism in prepubertal children and adolescents: comparison of clinical and biochemical features at diagnosis and response to medical therapy, Thyroid., 7: 755-760
http://dx.doi.org/10.1089/thy.1997.7.755

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