Thyrotoxicosis in Children: Treatment and Outcome
Somchit Jaruratanasirikul MD*, Kalaya Leethanaporn MSc**, Hutcha Sriplung MD***
Affiliation : * Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla ** Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla *** Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla
Objectives : To study the treatment modalities and the outcome of treatments of children with thyrotoxicosis or
Graves’ disease.
Materials and Methods : A retrospective study of 56 patients diagnosed with thyrotoxicosis from January 1992
to December 2004 was conducted. There were 44 girls and 12 boys (female to male ratio 3.7:1). The average
age at diagnosis was 11.9 (cid:31) 3.4 years.
Results : All patients were initially treated with antithyroid drugs, either propylthiouracil (n = 53) or methi-
mazole (n = 3). All patients achieved euthyroidism within 8.4 (cid:31) 3.3 weeks. Eleven patients are still on the
treatment, and 45 patients have completed the treatment. Of these 45 patients, 38 (84.4%) remitted after
antithyroid drug treatment of an average duration of 37.4 (cid:31) 16.5 months (range 12-90), 4 patients (8.9%)
chose radioactive iodine treatment and three patients (6.7%) underwent thyroidectomy. Of the 38 patients
remitted with antithyroid drugs, eleven (28.9%) relapsed within 4-24 months. The relapsed patients remitted
with a second course of antithyroid drugs in three patients, underwent radioactive iodine in seven patients,
and thyroidectomy in one patient. Therefore, of the total 45 patients who had completed the treatment, 30
patients (66.7%) remitted with antithyroid drugs, eleven patients (24.4%) received radioactive iodine, and
four patients (8.9%) underwent thyroidectomy. Using stepwise multivariate logistic regression, the authors
could not identify any factors (including age, gender, family history of thyroid diseases, size of goiter, level of
free T4, dosage and duration of antithyroid drugs) that would predict the remission of thyrotoxicosis with
antithyroid drugs.
Conclusion : Antithyroid drugs should remain the first-line therapy for treatment of thyrotoxicosis in children
with a remission rate of 66.7%. The patients who are noncompliant or relapse after treatment with antithyroid
drugs should be treated with radioactive iodine.
Keywords : Graves’ disease, Hyperthyroidism, Thyrotoxicosis
