DIAGNOSIS AND TREATMENT OF THYROTOXICOSIS IN CHILDHOOD - A EUROPEAN QUESTIONNAIRE STUDY

A covering letter and a questionnaire covering the diagnosis and treat ment of thyrotoxicosis in childhood was circulated between October 199 2 and February 1993 amongst 672 European members of the European Thyro id Association (ETA) and members of the European Society for Pediatric Endocrinology (ESPE). Almost 50% replied to the letter and 99 individ uals or groups from 22 countries completed the questionnaire. A consen sus was reached on the use of total thyroxine (T-4) and/or free T-4 an d thyrotropin as routine diagnostic tools. Two-thirds included total t riiodothyronine (T-3) and/or free T-3 and 32% used a thyrotropin-relea sing hormone test. Surprisingly, thyroglobulin autoantibodies were use d as a routine test by 78%; 63% included thyrotropin receptor antibodi es and 60% microsomal antibodies, whereas only 50% measured thyroperox idase antibodies. For thyroid imaging, 40% performed a thyroid scintig ram and 56% measured the size of the thyroid gland by ultrasound. Anti thyroid drugs (ATD) were the basic initial treatment of choice given b y 99% of the respondents for children with uncomplicated Graves' disea se. Carbimazole, methimazole and thiamazole were the most frequently u sed drugs, with a median initial dose of 0.8 mg.kg(-1).day(-1). Two-th irds added beta-blockers and a few used sedatives. The ATD dose was ad justed for each patient by 39%, whereas 56% combined ATD with T-4 for long-term treatment; 84% gave treatment for a fixed period (44% for 1- 2 years). Surgery was considered the treatment of choice in children w ith an adenoma (83%), with a nodular (53%) or large goiter (16%) and r ecurrence after ATD (14%). Radioiodine was the treatment of choice by 18% of the respondents for patients with recurrence after surgery and recurrence after ATD (7%).