Abstract
Introduction
Hyperthyroidism is a disease characterized by high total T4, T3, free T4, T3, and suppressed thyroid stimulating hormone (TSH), most seen in childhood due to Graves’ disease. This study aimed to examine the diagnostic features and treatment follow-up of hyperthyroid patients diagnosed and treated in our clinic.
Materials and Methods
Ten patients between the ages of 0-18 were included in the study. All patients’ free T4, T3, TSH, liver function tests, complete blood count, thyrotropin receptor antibody (TRAb) anti-thyroid peroxidase antibody, anti-thyroglobulin antibody, and thyroid ultrasonography results were evaluated at the time of diagnosis. Treatment and follow-up were started. Descriptive statistical analyses were performed using the IBM SPSS 29.0.2.0 statistical package program.
Results
Nine of the patients were female, and the mean age at diagnosis was 15.11±2.22 years. The most common complaint at presentation was weight loss. All patients had thyromegaly, and half of the patients had exophthalmos. Free T4 was 2.19±0.55 ng/dl, free T3 was 12.12±6.64 ng/dl, and TSH was 0.01 (0-0.04) mU/L at presentation. Anti-TPO and anti-TG autoantibodies were positive in all patients, while TRAb was also positive in 9 patients. All patients were started on methimazole treatment (mean 0.22±0.11 mg/kg/day), and beta-blocker treatment was started in patients with tachycardia. TSH level normalized in 4.8 months (2-10 months). The median follow-up duration was 6.8 months (4-10 months), and the median final dose was calculated as 0.02 mg/kg/day (0.01-0.11 mg/kg/day). Munchausen syndrome was diagnosed in one patient in whom the fT3 increase continued despite high-dose methimazole treatment. The patient, who had elevated AST and ALT levels and liver-kidney microsomal-1 antibody positivity, was diagnosed with autoimmune hepatitis type 2 and investigated for autoimmune polyglandular syndromes.
Conclusion
The most common cause of hyperthyroidism in childhood is Graves’ disease. It is more common in girls and after age 15, and the most common complaint is weight loss. As we have seen in our study, high-dose methimazole is not required in the treatment. Treatment compliance should be questioned in cases that cannot be controlled with appropriate treatment. It should be kept in mind that other autoimmune diseases may also occur at the time of diagnosis or during follow-up.
Keywords: Graves, hashitoxicosis, hyperthyroidism, methimazole, thyromegaly
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