Pediatric Hyperthyroidism – How to Manage Pediatric Hyperthyroidism in Children and Adolescents

Children may develop a form of hyperthyroidism specifically called pediatric hyperthyroidism. Although the symptoms are more or less the same with the adults, there has been much more controversy surrounding the treatment of this condition in children. Graves’ disease is usually one of the common culprits of the excessive thyroid hormone production in pediatric cases so this bears watching.

Antithyroid Drugs

Antithyroid drugs work in several ways from blocking the oxidzation of iodine to reducing the rate of iodide trapping. Most common in this category of drugs are propylthiouracil and its similar compounds methimazole and carbimazole.

Patients with hypersecreting thyroids may be treated with the drugs above to prevent the formation of thyroid hormone from tyrosine and iodine. This is one of the most commonly used treatments for children and a study reports the achievement of long-term remission with the use of antithyroid drugs alone following a mean treatment duration of around 3 years.

Block-replacement is another method which utilizes high doses of antithyroid drugs with subsequent replacement of iodine is more convenient than the titration regimen. Block-replacement usually requires around 3 hospital visits a year, whereas the titration regimen could require twice more.

Radioiodine

The thyroid gland normally takes up about a fifth of the ingested iodides. This happens because of an active pump in the thyroid cells that effectively trap the circulating iodides in the bloodstream into the thyroid. These iodides are then oxidized and then bound to the tyrosine residues inside the thyroglobulin molecule inside the gland.

However, if the iodine that has been absorbed by the thyroid gland possesses some degree of radioactivity, this could kill the hyperactive thyroid cells rather efficiently. This method has been used in place of levothyroxine methods but it is not without its hang-ups. A possible risk of the use of radioiodine is the development of extrathyroidal carcinoma or cancer in other tissues aside from the thyroid. This treatment can also cause hypothyroidism in patients so the dose must be carefully considered.

Surgery

Before the development of radioiodine and other antithyroid drugs, surgery was the easiest way to treat hyperthyroid patients. This procedure entails the complete or partial removal of the thyroid gland through surgical means and patients are usually given this option when they fail to respond favorably to other forms of treatment.

Prior to the development of modern pre-operative procedures, the mortality of thyroid surgery was as high as 1 in every 25 operations. Now, this has been reduced to around 1 in 1000 operations only.

Weeks or months prior to surgery, the patient must be treated with propylthiouracil or its similar compounds until such time that his metabolic rates return to normal. Then, one to two weeks immediately before the operation, high doses of inorganic iodides are administered to the patient. This reduces the swelling of the thyroid gland, which makes for a smaller surgical cut. The latter also diminishes the blood supply of the thyroid, which means there will be less bleeding.

In treating cases of pediatric hyperthyroidism, it is necessary that the family be advised properly on the possible outcomes and risks involved in each treatment. The family must also know the processes involved in each treatment. It is the duty of the physician to inform the family of their patients on the available treatments for this condition and aid them make better choices for their children.



Source by Ryan English

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