Department of Paediatric Endocrinology, Royal Manchester Children's Hospital. Manchester University NHS Foundation Trust, Manchester, UK
Department of Paediatric Endocrinology, Royal Manchester Children's Hospital. Manchester University NHS Foundation Trust, Manchester, UK.
BMJ Paediatr Open. 2022 Nov;6(1). doi: 10.1136/bmjpo-2022-001582.
Thyrotoxicosis due to hyperthyroidism is a serious disorder in childhood often presenting to general paediatricians with a range of clinical manifestations. The commonest cause is Graves' disease, an autoimmune disorder resulting from thyrotropin receptor stimulation by autoantibodies. Early recognition and accurate interpretation of investigations are essential to achieve and maintain a euthyroid state. This will not only optimise growth, development and transition from childhood to young adult life but also avoid the potentially severe and life-threatening complications of acute thyrotoxicosis. In this review, we have focussed on the general paediatrician's perspective of the presentation and management of thyrotoxicosis and the need to network with specialist paediatric endocrine centres to optimise patient care. We have discussed nuances of therapy, side effects and long-term outcomes, while recognising that limited remission rates in this age group often necessitate more definitive management. While carbimazole is usually used as first-line medical therapy, we have provided useful information to guide paediatricians in the discussion of individualised safe and effective treatment plans for both short-term and long-term management.
由于甲状腺功能亢进引起的甲状腺毒症是一种严重的儿童疾病，常由普通儿科医生治疗，其临床表现多种多样。最常见的病因是 Graves 病，这是一种自身免疫性疾病，是由自身抗体刺激促甲状腺激素受体引起的。早期识别和准确解读检查结果对于达到和维持甲状腺功能正常状态至关重要。这不仅可以优化生长、发育以及从儿童期向青年期的过渡，还可以避免急性甲状腺毒症的潜在严重和危及生命的并发症。在这篇综述中，我们重点关注普通儿科医生对甲状腺毒症的表现和管理的观点，以及与儿科内分泌中心建立联系以优化患者治疗的必要性。我们讨论了治疗的细微差别、副作用和长期结果，同时认识到该年龄段的缓解率有限，通常需要更明确的治疗方法。虽然卡比马唑通常被用作一线药物治疗，但我们提供了有用的信息，以指导儿科医生讨论针对短期和长期管理的个体化安全有效的治疗计划。
