Thyrotoxicosis in children: thirty years' experience

Optimal treatment for thyrotoxicosis remains controversial in adults, but m ore so in paediatric practice. We have conducted a retrospective review of the records of 76 paediatric patients seen between 1965 and 1995 to determi ne management practice and outcome of therapeutic interventions. Seventeen are currently on antithyroid drug (ATD) treatment, while four have had thei r care transferred. Of the remaining 55, 21 (38%) achieved long-term remiss ion with ATD alone following a mean treatment duration of 3.3 y (range 0.5- 7 y). Block-replacement thigh dose of ATD with thyroxine replacement) was m ore convenient than the titration regimen (3.4 +/- 0.3 visits to hospital p er year versus 6.1 +/- 0.4, p <0.001). Surgery (subtotal/total thyroidectom y) was carried out in 27 patients, of whom 24 subsequently became hypothyro id and were treated with thyroxine. I-131 was used successfully in six pati ents, two following surgery. ATD should remain the first-line therapy; a bl ock-replacement regimen is more convenient. Surgery in a specialized centre carries a low risk. Caution should still be exercised in the use of I-131 in young children.