HYPERTHYROIDISM IN CHILDREN - CLINICAL AND DEMOGRAPHIC REVIEW

Abstract

INTRODUCTION
Acquired hyperthyroidism in children is rare with reported incidence of 0.9 per 100, 000<15 years-old in UK and Ireland. The most common causes are Hashimoto’s thyrotoxicosis (HT) and Graves’ disease (GD). Children with Down syndrome (DS) are at higher risk to have thyroid disease.

METHODOLOGY
This is a retrospective, descriptive study looking at children with confirmed diagnosis of hyperthyroidism seen at paediatric endocrine unit, University Malaya Medical Centre. Patients demography and clinical profiles were obtained through medical record system.

RESULTS
A total of 20 patients were diagnosed from 2006-2018. Female predominates with the ratio of 3:1. There were 50% Malay, 45% Chinese and 5% Indian. Their mean age at diagnosis was 9.9±4.3 years. Two (10%) were diagnosed<5 years-old, 35% between 5-9 years, 35% between 10-14 years and 20% between 15-20 years-old. 45% had positive family history. Thirteen (65%) were diagnosed with GD, 20% had HT, 5% had multinodular goitre, TSH resistance syndrome and antibody negative hyperthyroidism respectively. Four (20%) of them had DS. At presentation, 50% had weight loss, 35% had goitre, 30% had palpitations and hyperactivity, 20% diarrhea, heat intolerance and lethargy, 15% had eye symptoms and excessive diaphoresis, 10% had sleep disturbances and deteriorated school performance and 5% had thyrotoxic hypokalemic periodic paralysis and acute psychosis. Of the 13 patients diagnosed with GD confirmed with positive autoantibody (TRab and TSI), 85% were female, and 30.8% had eye signs. No thyroid storm or hypertensive crisis recorded. These children have had symptoms with a mean duration of 15.8±16.6 weeks prior to diagnosis.

CONCLUSION
Despite common manifestation of acquired hyperthyroidism, there is a marked delay in diagnosis. Diagnosis of GD should not rely on eye symptoms alone and routine tests for TRAb/TSI should be done to confirm diagnosis.