Perrild H, Grüters-Kieslich A, Feldt-Rasmussen U, Grant D, Martino E, Kayser L, Delange F
Department of Medicine B, Bispebjerg University Hospital, Copenhagen, Denmark.
Eur J Endocrinol. 1994 Nov;131(5):467-73. doi: 10.1530/eje.0.1310467.
A covering letter and a questionnaire covering the diagnosis and treatment of thyrotoxicosis in childhood was circulated between October 1992 and February 1993 amongst 672 European members of the European Thyroid Association (ETA) and members of the European Society for Pediatric Endocrinology (ESPE). Almost 50% replied to the letter and 99 individuals or groups from 22 countries completed the questionnaire. A consensus was reached on the use of total thyroxine (T4) and/or free T4 and thyrotropin as routine diagnostic tools. Two-thirds included total triiodothyronine (T3) and/or free T3 and 32% used a thyrotropin-releasing hormone test. Surprisingly, thyroglobulin autoantibodies were used as a routine test by 78%; 63% included thyrotropin receptor antibodies and 60% microsomal antibodies, whereas only 50% measured thyroperoxidase antibodies. For thyroid imaging, 40% performed a thyroid scintigram and 56% measured the size of the thyroid gland by ultrasound. Antithyroid drugs (ATD) were the basic initial treatment of choice given by 99% of the respondents for children with uncomplicated Graves' disease. Carbimazole, methimazole and thiamazole were the most frequently used drugs, with a median initial dose of 0.8 mg.kg-1.day-1. Two-thirds added beta-blockers and a few used sedatives. The ATD dose was adjusted for each patient by 39%, whereas 56% combined ATD with T4 for long-term treatment; 84% gave treatment for a fixed period (44% for 1-2 years). Surgery was considered the treatment of choice in children with an adenoma (83%), with a nodular (53%) or large goiter (16%) and recurrence after ATD (14%).(ABSTRACT TRUNCATED AT 250 WORDS)
1992年10月至1993年2月期间，一封关于儿童甲状腺毒症诊断与治疗的附函及调查问卷在欧洲甲状腺协会（ETA）的672名欧洲成员和欧洲儿科内分泌学会（ESPE）成员之间传阅。近50%的人回复了信件，来自22个国家的99个人或团体完成了调查问卷。就将总甲状腺素（T4）和/或游离T4及促甲状腺激素用作常规诊断工具达成了共识。三分之二的人将总三碘甲状腺原氨酸（T3）和/或游离T3纳入其中，32%的人使用促甲状腺激素释放激素试验。令人惊讶的是，78%的人将甲状腺球蛋白自身抗体用作常规检测；63%的人纳入了促甲状腺激素受体抗体，60%的人纳入了微粒体抗体，而只有50%的人检测了甲状腺过氧化物酶抗体。对于甲状腺成像，40%的人进行了甲状腺闪烁扫描，56%的人通过超声测量甲状腺大小。抗甲状腺药物（ATD）是99%的受访者对单纯性格雷夫斯病患儿的首选初始基本治疗药物。卡比马唑、甲巯咪唑和硫唑嘌呤是最常用的药物，初始中位剂量为0.8mg·kg⁻¹·d⁻¹。三分之二的人加用了β受体阻滞剂，少数人使用了镇静剂。39%的人根据每位患者的情况调整ATD剂量，而56%的人将ATD与T4联合用于长期治疗；84%的人进行固定疗程的治疗（44%为1 - 2年）。对于患有腺瘤（83%）、结节性甲状腺肿（53%）或巨大甲状腺肿（16%）以及ATD治疗后复发（14%）的儿童，手术被视为首选治疗方法。（摘要截选至250词）
