ESPE Abstracts (2015) 84 P-3-1213

ESPE2015 Poster Category 3 Thyroid (64 abstracts)

Hyperthyroidism in Children and Adolescents: Causes, When and How to Treat – A Tunisian Experience

Essaddam Leïla , Kallali Wafa , Guedri Rahma , Fitouri Zohra , Matoussi Nadia & Ben Becher Saayda

Children Hospital Bechir Hamza of Tunis, Service PUC, Tunis, Tunisia

Background: Hyperthyroidism is considered to be rare in children; its clinical profile is different and the most cause is Grave’s disease (GD).

Objective and hypotheses: To evaluate clinical features and evolution of childhood hyperthyroidism.

Method: Longitudinal retrospective study of children diagnosed with hyperthyroidism in an endocrinology unit in a children hospital in Tunisia.

Results: Seven cases of hyperthyroidism were identified from 2000 to 2015 with a sex-ratio of five girls for two boys. The patients’ average age at diagnosis was 6.3 years (7 days–10 years). Appearing symptoms were dominated by goiter in six cases, tachycardia in five cases, exophtalmia in four cases and loss of weight in two cases. In the laboratory evaluation, we highlight: TSH suppression in six/seven patients, raised fT4 in all patients; Trab were elevated in three cases, elevated titles of antiperoxidase were found in three cases. In the imaging evaluation, the thyroid gland was homogenous and diffusely enlarged in three cases, normal in one case and multinodular in two cases. Causes of hyperthyroidism were dominated by Grave’s disease in 5 children associated with Down Syndrom in one case and with coeliac disease in another one. Other causes were thyroïditis (one case) and a rare case of resistance to the thyroid hormones confirmed by molecular biology. All the patients except the one with resistance to the thyroid hormones received a drug therapy. The remission was obtained under carbimazole in two patients. Other patients have been treated for more than 2 years. Additional treatment with β-blockers have been used in 3 patients. No iodine or surgical treatment have been made. The patient with resistance to thyroid hormones do not receive any treatment.

Conclusion: Grave’ disease is the most common cause of hyperthyroidism in children. Nevertheless, we shouldn’t forget more rare aetiologies. Treatment is based on antithyroid drugs (ATD) with a low remission rate. The use of scores for identification of predictive factors of the risk of relapse after ATD treatment will lead to improvements in patient management.

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