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    Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience
    (2019) Esen, İhsan; Bayramoğlu, Elvan; Yıldız, Melek; Aydın, Murat; Özturhan, Esin; Aycan, Zehra; Sağsak, Elif
    Objective: To determine the demographic and biochemical features of childhood and juvenile thyrotoxicosis and treatment outcome.Methods: We reviewed the records of children from 22 centers in Turkey who were diagnosed with thyrotoxicosis between 2007 to 2017.Results: A total of 503 children had been diagnosed with thyrotoxicosis at the centers during the study period. Of these, 375 (74.6%)had been diagnosed with Graves’ disease (GD), 75 (14.9%) with hashitoxicosis and 53 (10.5%) with other less common causes ofthyrotoxicosis. The most common presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitations, weightloss and excessive sweating. The cumulative remission rate was 17.6% in 370 patients with GD who had received anti-thyroid drugs(ATDs) for initial treatment. The median (range) treatment period was 22.8 (0.3-127) months. No variables predictive of achievingremission were identified. Twenty-seven received second-line treatment because of poor disease control and/or adverse events associatedwith ATDs. Total thyroidectomy was performed in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Tenpatients received radioiodine and six became hypothyroid, one remained hyperthyroid and restarted ATDs and one patient achievedremission. Two patients were lost to follow up.Conclusion: This study has demonstrated that using ATDs is the generally accepted first-line approach and there seems to be lowremission rate with ATDs in pediatric GD patients in Turkey.