Endocrine Abstracts

JOINT1774

Aim: Hyperthyroidism is rare in childhood, and its diagnosis may be delayed. The approaches to follow-up and treatment are varied, and evidence-based guidelines are lacking. This study aimed to evaluate the presentation and follow-up characteristics of patients with hyperthyroidism.

Material and Methods: Patients aged 1 to 18 years diagnosed with hyperthyroidism and admitted between September 2005 and January 2023, with complete data available, were included. Admission and follow-up characteristics were recorded from their files. The etiology of hyperthyroidism, treatment, response to therapy, and follow-up periods were evaluated. The statistical analysis was performed using the Statistical Package for Social Sciences (SPSS, Version 26.0, Chicago, IL).

Results: The mean age of the 63 patients included in the study was 11.7±4.95 years, and the female/male ratio was 1.86. Forty-eight (76.2%) of the patients were diagnosed with Graves’ disease (GD), with Hashitoxicosis (n = 9, 14.3%) being the second most common diagnosis. The mean age was 12.03±4.52 years in patients with GD and 14.94±3.44 years in patients with Hashitoxicosis (p:0.04). Ophthalmopathy was found in seven patients (11.1%). Euthyroidism was achieved in 60 patients in whom antithyroid drug (ATD) treatment was initiated in a mean of 7±8.29 months (71.4% in the first six months). No side effects were observed with ATDs except allergic rash in two patients. The mean duration of treatment was 25.03±22.9 months and was longer in patients with GD than in patients with Hashitoxicosis (30±23.4 months vs. 6.1±6.6 months, P = 0.002). The mean follow-up period was 36.9±32.3 months. While the remission rate during the follow-up period was 22.9% in patients receiving ATDs for GD, 15 of 48 patients (31.3%) relapsed after a mean of 8.4±5.02 months. Thyroidectomy was performed in 11 (17.5%) patients (9 with GD, 2 with toxic adenoma). Thyroidectomy was more frequent in the presence of ophthalmopathy (P = 0.018) and in patients with larger thyroid gland volume (P = 0.044) and volume SDS (P = 0.001). It was found that the time to achieve euthyroidism (P = 0.0015) and the time to TRAb negativity (P = 0.022) were longer in those who underwent thyroidectomy compared to those who didn’t.

Conclusion: In the majority of children with hyperthyroidism, euthyroidism can be achieved in the first six months with ATDs. In children with GD, the long-term remission rate with ATDs is low. Thus, permanent treatment is likely to be required in the presence of large goiter, ophthalmopathy, and in patients in whom biochemical euthyroidism and TRAb negativity cannot be achieved with long-term treatment.