Endocrinology

Thyrotoxicosis in Childhood

This study was undertaken from September 2004 to September 2005. This study aimed to be a comprehensive survey of childhood thyrotoxicosis in the UK and Ireland. It aimed to identify the incidence of childhood Graves' disease and of the other causes of childhood thyrotoxicosis. It also aimed to describe the presenting features of thyrotoxicosis in children and the initial management received.

By bpsu · September 1, 2004

Lead investigator

Dr S Williamson

About the study

Graves’ disease was known to be the commonest cause of thyrotoxicosis in the general population (60-90% of cases worldwide), followed by rarer causes such as solitary thyroid adenomas, multinodular goitre and, in neonates, congenital Graves’ disease.  Data from other countries in Europe reported incidences of Graves’ disease in childhood from 0.79/100,000 per year (Denmark) to 8/100,000 per year (Iceland, 10-19 year olds). The incidence in Hong Kong was recently reported as 6.5/100,000 per year.

In some countries, the incidence of Graves’ disease was increasing and increased dietary intake of iodine has been implicated. Other than this, the aetiology of Graves’ disease was unknown; however, genetic susceptibility, puberty and emotional stress were known contributing factors.

There was no clear pattern of practice in investigating thyrotoxicosis. The gold standard for detecting primary hyperthyroidism was a suppressed thyroid-stimulating hormone (TSH), but diagnosing the underlying condition may have been more difficult. Clinicians may have relied on history, clinical findings and basic thyroid function tests to diagnose Graves’ disease, or they may have wished to investigate further to distinguish it from the other rarer forms of thyrotoxicosis in childhood, which may have presented with identical symptoms and signs.

Treatment options for the child with Graves’ disease were medical (antithyroid drugs), surgery and radioiodine. There were worldwide debates over the safest and most effective use of these treatments in children. In Europe, antithyroid drugs had been favoured.

This study aimed to be a comprehensive survey of childhood thyrotoxicosis in the UK and Ireland. It would make available the best data on the incidence, patterns of presentation and management of this disease.

The study aimed to identify:

  • What was the incidence of childhood Graves’ disease in the UK and Ireland?
  • What are the incidences of the other causes of childhood thyrotoxicosis in the UK and Ireland?
  • What are the presenting features of thyrotoxicosis in children?
  • What initial management was received by children in the UK and Ireland diagnosed with thyrotoxicosis?

Duration

September 2004 – September 2005

Published papers

Williamson, S., & Greene, S. A. (2010). Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland. Clinical Endocrinology, 72(3), 358-363. https://doi.org/10.1111/j.1365-2265.2009.03717.x

British Thyroid Foundation
Web: http://www.btf-thyroid.org Email: info@btf-thyroid.org