Mooij Christiaan F, Zwaveling-Soonawala Nitash, Hillebrand Jacquelien J, van Trotsenburg A S Paul
Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
Endocrine Laboratory, Department of Laboratory Medicine, Amsterdam University Medical Centers, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
J Clin Endocrinol Metab. 2025 Feb 18;110(3):e878-e885. doi: 10.1210/clinem/dgae592.
Graves' disease (GD) is the leading cause of hyperthyroidism in children. However, compared to adults, GD in children is a rare condition. In a recent guideline issued by the European Thyroid Association, the diagnostic evaluation and treatment of pediatric GD is described extensively. In this article, we go beyond the guideline and describe the potential challenges of establishing the right etiology of thyrotoxicosis in children, illustrated by cases of thyroid hormone resistance, autonomous functioning thyroid nodules, and subacute thyroiditis with a thyrotoxic phase. In addition, we report therapeutic challenges in pediatric GD such as recurrent immunological flare-ups under antithyroid drug (ATD) treatment, innovative ways to improve ATD compliance and the role of definitive treatment in persistent complaints of malaise under ATD treatment.
格雷夫斯病（GD）是儿童甲状腺功能亢进症的主要病因。然而，与成人相比，儿童GD较为罕见。欧洲甲状腺协会最近发布的一项指南对儿童GD的诊断评估和治疗进行了详尽描述。在本文中，我们超越该指南，阐述了确定儿童甲状腺毒症正确病因时可能面临的挑战，以甲状腺激素抵抗、自主性功能性甲状腺结节以及伴有甲状腺毒症期的亚急性甲状腺炎病例为例进行说明。此外，我们还报告了儿童GD的治疗挑战，如抗甲状腺药物（ATD）治疗下的反复免疫性发作、提高ATD依从性的创新方法以及在ATD治疗下持续不适主诉中确定性治疗的作用。
