Management of Thyrotoxicosis in Children and Adolescents: A Turkish Multi-center Experience

J Clin Res Pediatr Endocrinol. 2019 May 28;11(2):164-172. doi: 10.4274/jcrpe.galenos.2018.2018.0210. Epub 2018 Nov 29.


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 of thyrotoxicosis. The most common presenting features in children with GD or hashitoxicosis were tachycardia and/or palpitations, weight loss 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 achieving remission were identified. Twenty-seven received second-line treatment because of poor disease control and/or adverse events associated with ATDs. Total thyroidectomy was performed in 17 patients with no recurrence of thyrotoxicosis and all became hypothyroid. Ten patients received radioiodine and six became hypothyroid, one remained hyperthyroid and restarted ATDs and one patient achieved remission. 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 low remission rate with ATDs in pediatric GD patients in Turkey.

Keywords: Graves’ disease; hashitoxicosis; thyrotoxicosis; antithyroid drug; radioactive iodine; total thyroidectomy.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Antithyroid Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Combined Modality Therapy
  • Disease Management
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Thyroidectomy / methods*
  • Thyrotoxicosis / therapy*
  • Treatment Outcome


  • Antithyroid Agents