Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients

The course of Graves' thyrotoxicosis in 7 prepubertal children (6.4 +/- 2.4 yr) was compared with that in 21 pubertal (12.5 +/- 1.1 yr) and 12 postpub ertal (16.2 +/- 0.84 yr) patients. In the prepubertal group the main compla ints were weight loss and frequent bowel movements (86%), whereas typical s ymptoms (irritability, palpitations, heat intolerance, and neck lump) occur red significantly less often (P < 0.01). The most prominent manifestation a t diagnosis was accelerated growth and bone maturation: their height so sco re was significantly greater than that of the pubertal and postpubertal pat ients (2.6 +/- 0.7 vs. 0.15 +/- 0.65 and 0.15 +/- 0.9, respectively, P < 0. 001), and their bone age to chronological age ratio was 1.39 +/- 0.35 compa red with 0.98 +/- 0.06 in the pubertal children (P = 0.02). T-3 levels were also significantly higher than in the other two groups (9.9 +/- 2.9 nmol/L us. 6.32 +/- 1.9 nmol/L and 6.02 +/- 2.0 nmol/L, P = 0.01). All patients were initially prescribed antithyroid drugs (ATDs). Overall, a dverse reactions to ATDs occurred in 35%, with a higher rate among the prep ubertal children (71%) than the pubertal (28%) and postpubertal (25%) patie nts (P = 0.08). Major adverse reactions were noted in two children, both pr epubertal. Remission was achieved in 10 patients (28%). Although the rate o f remission did not differ among the three groups, time to remission tended to be longer in the prepubertal children (P = 0.09). In conclusion, thyrotoxicosis has an atypical presentation and more severe course in prepubertal children. Considering their adverse reactions to ATD, overall low remission rate, and long period to remission, definitive treat ment should be considered earlier in this age group.