Childhood Thyrotoxicosis: A Long-term Perspective

Abstract

An unusual perspective on childhood thyrotoxicosis has been provided by reviewing 70 patients cared for over the past 20 years, 52 of whom were treated surgically. The disease appears to have a higher incidence in the USA than elsewhere. A genetic influence was suggested by the frequency of disorders in close relatives of the patients. The onset of thyrotoxicosis was often related to physical or psychological stress. The clinical manifestations were easily recognizable and diagnosis required few laboratory aids. In view of the lack of proper understanding of the etiology, cure has not been achieved. Good control was, however, obtained with surgical treatment. Though certain underlying genetic and psychosomatic characteristics tended to persist after treatment, the physical, emotional, and mental development of these children was not affected. Hypothyroidism and tetany were serious complications of surgical treatment, and the frequency of their occurrence indicated the need for better therapeutic measures. Medical treatment of juvenile thyrotoxicosis emerges as even less satisfactory. The incidence of failure, recurrence, and toxicity is so high that ultimately recourse to surgery is necessary in l/4th of the patients. The inadequacy of the methods at present available necessitates urgent search for better therapeutic measures. Radioiodine treatment has proved to be eminently suitable for adults. The question whether this might prove useful in children also is still unanswered. Experience with this method, though not extensive, appears hopeful enough to justify its further exploration under careful qualified medical supervision, with special emphasis on long-term follow-up.