Cargando…

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

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 ques...

Descripción completa

Detalles Bibliográficos
Autores principales: Kourime, Mariam, McGowan, Sheena, Al Towati, Mabrouka, Ahmed, S Faisal, Stewart, Graham, Williamson, Scott, Hunter, Iain, Donaldson, Malcolm D C
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047164/
https://www.ncbi.nlm.nih.gov/pubmed/29269558
http://dx.doi.org/10.1136/archdischild-2017-313454
_version_ 1783339911528579072
author Kourime, Mariam
McGowan, Sheena
Al Towati, Mabrouka
Ahmed, S Faisal
Stewart, Graham
Williamson, Scott
Hunter, Iain
Donaldson, Malcolm D C
author_facet Kourime, Mariam
McGowan, Sheena
Al Towati, Mabrouka
Ahmed, S Faisal
Stewart, Graham
Williamson, Scott
Hunter, Iain
Donaldson, Malcolm D C
author_sort Kourime, Mariam
collection PubMed
description 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.
format Online
Article
Text
id pubmed-6047164
institution National Center for Biotechnology Information
language English
publishDate 2018
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-60471642018-07-18 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 Kourime, Mariam McGowan, Sheena Al Towati, Mabrouka Ahmed, S Faisal Stewart, Graham Williamson, Scott Hunter, Iain Donaldson, Malcolm D C Arch Dis Child Original Article 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. BMJ Publishing Group 2018-07 2017-12-21 /pmc/articles/PMC6047164/ /pubmed/29269558 http://dx.doi.org/10.1136/archdischild-2017-313454 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Original Article
Kourime, Mariam
McGowan, Sheena
Al Towati, Mabrouka
Ahmed, S Faisal
Stewart, Graham
Williamson, Scott
Hunter, Iain
Donaldson, Malcolm D C
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
title 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_short 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
title_sort 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
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6047164/
https://www.ncbi.nlm.nih.gov/pubmed/29269558
http://dx.doi.org/10.1136/archdischild-2017-313454
work_keys_str_mv AT kourimemariam longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT mcgowansheena longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT altowatimabrouka longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT ahmedsfaisal longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT stewartgraham longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT williamsonscott longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT hunteriain longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling
AT donaldsonmalcolmdc longtermoutcomeofthyrotoxicosisinchildhoodandadolescenceinthewestofscotlandthecaseforlongtermantithyroidtreatmentandtheimportanceofinitialcounselling