Lazar L, Kalter-Leibovici O, Pertzelan A, Weintrob N, Josefsberg Z, Phillip M
Institute for Endocrinology and Diabetes, Schnieder Children's Medical Center of Israel, Petah Tiqva.
J Clin Endocrinol Metab. 2000 Oct;85(10):3678-82. doi: 10.1210/jcem.85.10.6922.
The course of Graves' thyrotoxicosis in 7 prepubertal children (6.4+/-2.4 yr) was compared with that in 21 pubertal (12.5+/-1.1 yr) and 12 postpubertal (16.2+/-0.84 yr) patients. In the prepubertal group the main complaints were weight loss and frequent bowel movements (86%), whereas typical symptoms (irritability, palpitations, heat intolerance, and neck lump) occurred significantly less often (P < 0.01). The most prominent manifestation at diagnosis was accelerated growth and bone maturation: their height SD score was significantly greater than that of the pubertal and postpubertal patients (2.6+/-0.7 us. 0.15+/-0.65 and 0.15+/-0.9, respectively, P < 0.001), and their bone age to chronological age ratio was 1.39+/-0.35 compared with 0.98+/-0.06 in the pubertal children (P = 0.02). T3 levels were also significantly higher than in the other two groups (9.9+/-2.9 nmol/L vs. 6.32+/-1.9 nmol/L and 6.02+/-2.0 nmol/L, P = 0.01). All patients were initially prescribed antithyroid drugs (ATDs). Overall, adverse reactions to ATDs occurred in 35%, with a higher rate among the prepubertal children (71%) than the pubertal (28%) and postpubertal (25%) patients (P = 0.08). Major adverse reactions were noted in two children, both prepubertal. Remission was achieved in 10 patients (28%). Although the rate of remission did not differ among the three groups, time to remission tended to be longer in the prepubertal children (P = 0.09). In conclusion, thyrotoxicosis has an atypical presentation and more severe course in prepubertal children. Considering their adverse reactions to ATD, overall low remission rate, and long period to remission, definitive treatment should be considered earlier in this age group.
对7名青春期前儿童（6.4±2.4岁）、21名青春期儿童（12.5±1.1岁）和12名青春期后患者（16.2±0.84岁）的格雷夫斯甲状腺毒症病程进行了比较。青春期前组的主要症状是体重减轻和排便频繁（86%），而典型症状（易怒、心悸、不耐热和颈部肿块）出现的频率显著较低（P<0.01）。诊断时最突出的表现是生长加速和骨骼成熟：他们的身高标准差得分显著高于青春期和青春期后患者（分别为2.6±0.7 vs. 0.15±0.65和0.15±0.9，P<0.001），他们的骨龄与实际年龄之比为1.39±0.35，而青春期儿童为0.98±0.06（P=0.02）。T3水平也显著高于其他两组（9.9±2.9 nmol/L vs. 6.32±1.9 nmol/L和6.02±2.0 nmol/L，P=0.01）。所有患者最初均开具了抗甲状腺药物（ATD）。总体而言，35%的患者出现了ATD不良反应，青春期前儿童的发生率（71%）高于青春期（28%）和青春期后（25%）患者（P=0.08）。两名儿童出现了严重不良反应，均为青春期前儿童。10名患者（28%）实现了缓解。虽然三组的缓解率没有差异，但青春期前儿童的缓解时间往往更长（P=0.09）。总之，甲状腺毒症在青春期前儿童中表现不典型，病程更严重。考虑到他们对ATD的不良反应、总体缓解率低以及缓解期长，该年龄组应更早考虑确定性治疗。
