Juvenile thyrotoxicosis; can we do better?

Abstract

Thyrotoxicosis remains a frustrating condition for the young person, family, and health professionals involved. The associated symptoms do not always suggest thyroid disease and patients can be unwell for many months before the diagnosis is made. The antithyroid drug regimen used to treat children and adolescents with thyrotoxicosis varies from one unit to another and yet the potentially life threatening side effects and remission rates post-treatment may be related to the regimen used. Most patients with thyrotoxicosis will need many years of drug therapy if the thyroid gland is not removed surgically or destroyed by radioiodine. Even "definitive" treatment will typically necessitate thyroxine replacement for life.

Figure 1

Height SDS of patients with Graves' disease diagnosed in northeast England in recent years compared to mid-parental height SDS. Patients are significantly taller than would be expected based on parental size (p = 0.02).

Figure 2

Perioperative record of patient undergoing abdominal surgery who had unrecognised Graves' disease. A steady rise in temperature during the procedure and sudden rise in pulse rate can clearly be seen.