Document Detail


Clinical and endocrine features and long-term outcome of Graves' disease in early childhood.
MedLine Citation:
PMID:  17598970     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Hyperthyroidism is rare in early childhood and most commonly caused by Graves' disease. We report 14 children (4 boys, 10 girls) aged 3.4-7.5 yr. At diagnosis, all patients had weight loss, hyperkinetic activity, tachycardia, difficulty sleeping, and poor concentration and 11 presented with proptosis. Four patients developed long-term neuropsychological problems. There was a family history in 7 cases. All patients had goiters, clinically assessed to be large and diffuse in 21%, medium-sized in 43%, and small in 36%. At diagnosis, height was increased with median (range) height; 1.25 standard deviation score (SDS) (-0.2-5.24) and body mass index (BMI) was decreased; -0.48 SDS (-1.65-1.26). Height and BMI SDS values were statistically different (p<0.032) Bone age was advanced in 4 of 5 children, who had assessments. Total or free T4 levels were elevated and TSH was undetectable. Ninety percent of patients (12/14) had positive thyroid peroxidase autoantibodies, mean level 680 IU/ml (range 50-1347). Initial treatment was with antithyroid medication using carbimazole; median dose 0.75 mg/kg/day (no.=13) or propylthiouracyl 15 mg/kg/day (no.=1). T4 was added in 6 patients. Normalisation of serum T4 occurred at 4 months (1- 9) and TSH at 7 months (3-24) after start of therapy. Treatment was discontinued after a minimum of 2 yr in 11 patients, relapse occurring in 9. Median duration of total therapy was 58 months (18-132). During adolescence, 4 patients had curative therapy by surgery (no.=2) or radioiodine (no.=2). In conclusion, disturbance of growth, behavioral difficulties and infrequent spontaneous remission are key features of Graves' disease in early childhood.
Authors:
A T Bossowski; V Reddy; L A Perry; L B Johnston; K Banerjee; J C Blair; M O Savage
Publication Detail:
Type:  Clinical Trial; Journal Article    
Journal Detail:
Title:  Journal of endocrinological investigation     Volume:  30     ISSN:  1720-8386     ISO Abbreviation:  J. Endocrinol. Invest.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-06-29     Completed Date:  2007-07-25     Revised Date:  2009-02-05    
Medline Journal Info:
Nlm Unique ID:  7806594     Medline TA:  J Endocrinol Invest     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  388-92     Citation Subset:  IM    
Affiliation:
Department of Paediatric Endocrinology Barts and London School of Medicine and Dentistry, London, UK.
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MeSH Terms
Descriptor/Qualifier:
Age of Onset
Antithyroid Agents / administration & dosage
Attention Deficit Disorder with Hyperactivity / etiology
Carbimazole / administration & dosage
Child
Child, Preschool
Exophthalmos / etiology
Female
Graves Disease / complications*,  drug therapy,  immunology,  physiopathology*
Growth Disorders / etiology
Humans
Hyperkinesis / etiology
Iodide Peroxidase / immunology
Male
Propylthiouracil / administration & dosage
Recurrence
Retrospective Studies
Sleep Disorders / etiology
Tachycardia / etiology
Thyrotropin / blood
Thyroxine / blood
Weight Loss
Chemical
Reg. No./Substance:
0/Antithyroid Agents; 22232-54-8/Carbimazole; 51-52-5/Propylthiouracil; 7488-70-2/Thyroxine; 9002-71-5/Thyrotropin; EC 1.11.1.8/Iodide Peroxidase
Comments/Corrections
Comment In:
J Endocrinol Invest. 2008 Jun;31(6):582   [PMID:  18591895 ]

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