title: Thyrotoxicosis in children: treatment and outcome.
abstract: OBJECTIVE
  To study the treatment modalities and the outcome of treatments of children with thyrotoxicosis or Graves' disease.
  
  
  METHODS
  A retrospective study of 56 patients diagnosed with thyrotoxicosis from January 1992 to December 2004 was conducted. There were 44 girls and 12 boys (female to male ratio 3.7:1). The average age at diagnosis was 11.9 +/- 3.4 years.
  
  
  RESULTS
  All patients were initially treated with antithyroid drugs, either propylthiouracil (n = 53) or methimazole (n = 3). All patients achieved euthyroidism within 8.4 +/- 3.3 weeks. Eleven patients are still on the treatment, and 45 patients have completed the treatment. Of these 45 patients, 38 (84.4%) remitted after antithyroid drug treatment of an average duration of 37.4 +/- 16.5 months (range 12-90), 4 patients (8.9%) chose radioactive iodine treatment and three patients (6.7%) underwent thyroidectomy. Of the 38 patients remitted with antithyroid drugs, eleven (28.9%) relapsed within 4-24 months. The relapsed patients remitted with a second course of antithyroid drugs in three patients, underwent radioactive iodine in seven patients, and thyroidectomy in one patient. Therefore, of the total 45 patients who had completed the treatment, 30 patients (66.7%) remitted with antithyroid drugs, eleven patients (24.4%) received radioactive iodine, and four patients (8.9%) underwent thyroidectomy. Using stepwise multivariate logistic regression, the authors could not identify any factors (including age, gender, family history of thyroid diseases, size of goiter, level of free T4, dosage and duration of antithyroid drugs) that would predict the remission of thyrotoxicosis with antithyroid drugs.
  
  
  CONCLUSIONS
  Antithyroid drugs should remain the first-line therapy for treatment of thyrotoxicosis in children with a remission rate of 66.7%. The patients who are noncompliant or relapse after treatment with antithyroid drugs should be treated with radioactive iodine.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand. somchit.j@psu.ac.th
authors.forename: Somchit
authors.initials: S
authors.lastname: Jaruratanasirikul
authors.forename: Kalaya
authors.initials: K
authors.lastname: Leethanaporn
authors.forename: Hutcha
authors.initials: H
authors.lastname: Sriplung
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008713:Methimazole / Q000627:therapeutic use; D011441:Propylthiouracil / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes; D008713:Methimazole; D011441:Propylthiouracil