ESPE Abstracts

Introduction: Graves’ disease (GD) is a leading cause of hyperthyroidism in all age groups. Clinical presentation, methods and overall goals of therapy can be variable in different age groups. We aimed to study the prevalence of GD, the attitude of treating physicians towards management preferences as well as patient response pattern amongst children and adolescents with GD in Saudi Arabia.

Methods: A cross sectional, multicentre study at King Abdulaziz Medical City (KAMC) in Jeddah and Riyadh, Saudi Arabia (2009-2018). Data gathered via electronic medical records system for all patients diagnosed with thyrotoxicosis under 18 years of age. We excluded those with incomplete data.

Results: A total of 93 patients were enrolled. The mean age was 11.5 years at diagnosis with a female predominance (n=68, 73.1%) and unremarkable family history (n=53, 57%). The main causes were GD (n=60, 64.5%) and hashitoxicosis (n=10, 10.8%). Majority of thyrotoxicosis presented with goitre (57%) and tachycardia (55%). GD was mainly associated with exophthalmos, lid lag, sweating, tremor and weight loss (OR 3.71, 3.8, 2.77, 2.34, 2.28) respectively. Thyroid uptake scan showed increased uptake in n=29 (48.3%, P-value =0.029) in those who underwent scanning opposite to non-sensitive thyroid US results P-value= 0.228. Serum FT4 (n=32.6/ P-value= 0.000), FT3 (n=20.3 / 0.000), TSI (n=9.1 / 0.000), Anti TG (n=537.5 / 0.018) and Anti TPO (n=366.5/0.017) had biochemical significance in diagnosing GD as the cause of hyperthyroidism. Majority with GD were treated with only MMT (n=44, 73%), had good compliance (n=44, 73%) and no adverse effects (n=56, 93.3%). A definitive treatment was only used with RAI in (n=14, 23.3%) or thyroidectomy in (n=5, 8.3%) patients.

Conclusion: GD is a leading cause of hyperthyroidism in children and adolescent with updates on different approaches of management. Endocrinologists in Saudi Arabia favour the option of extended use of ATD