Clinical and endocrine features and long-term outcome of Graves' disease in early childhood.

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  • Additional Information
    • Source:
      Publisher: Springer Country of Publication: Italy NLM ID: 7806594 Publication Model: Print Cited Medium: Internet ISSN: 1720-8386 (Electronic) Linking ISSN: 03914097 NLM ISO Abbreviation: J Endocrinol Invest Subsets: MEDLINE
    • Publication Information:
      Publication: 2014- : Berlin : Springer
      Original Publication: Milano, Published for the Italian Society of Endocrinology by Editrice Kurtis.
    • Subject Terms:
      Graves Disease/*complications ; Graves Disease/*physiopathology; Age of Onset ; Antithyroid Agents/administration & dosage ; Attention Deficit Disorder with Hyperactivity/etiology ; Carbimazole/administration & dosage ; Child ; Child, Preschool ; Exophthalmos/etiology ; Female ; Graves Disease/drug therapy ; Graves Disease/immunology ; Growth Disorders/etiology ; Humans ; Hyperkinesis/etiology ; Iodide Peroxidase/immunology ; Male ; Propylthiouracil/administration & dosage ; Recurrence ; Retrospective Studies ; Sleep Wake Disorders/etiology ; Tachycardia/etiology ; Thyrotropin/blood ; Thyroxine/blood ; Weight Loss
    • Abstract:
      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.
    • Comments:
      Comment in: J Endocrinol Invest. 2008 Jun;31(6):582. (PMID: 18591895)
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    • Accession Number:
      0 (Antithyroid Agents)
      721M9407IY (Propylthiouracil)
      8KQ660G60G (Carbimazole)
      9002-71-5 (Thyrotropin)
      EC 1.11.1.8 (Iodide Peroxidase)
      Q51BO43MG4 (Thyroxine)
    • Publication Date:
      Date Created: 20070630 Date Completed: 20070725 Latest Revision: 20181113
    • Publication Date:
      20231215
    • Accession Number:
      10.1007/BF03346315
    • Accession Number:
      17598970