Menon P S, Singh G R
Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
J Pediatr Endocrinol Metab. 1996 Jul-Aug;9(4):441-6. doi: 10.1515/jpem.1996.9.4.441.
During the period 1986-1993, 24 children with hyperthyroidism were referred to us for management. Two of them had factitious hyperthyroidism, one toxic nodular goiter and another neonatal Graves' disease. Twenty children (6M, 14F) had Graves' disease. Their age at presentation was 10.86 +/- 2.02 years and duration of symptoms ranged from 2.5 months to 7 years. Neuropsychiatric manifestations, such as hyperkinesis, irritability, excitability and behavioral problems, were the most common initial presenting symptoms (90%). Goiter of varying grades was present in 18 children. Eye involvement of mild or moderate intensity was present in 85% and cardiac involvement in 30%. Serum free thyroxine and triiodothyronine levels were high and radioactive iodine uptake was elevated. All of them received carbimazole 0.5-0.7 mg/kg in three divided doses. Seventeen responded to therapy over a period of time while three did not. On withdrawal, six of the responders relapsed. Hyperthyroidism in children is rare and when it occurs it is almost always due to Graves' disease. The prominence of neuropsychiatric symptoms, insidious onset and absence of severe infiltrative ophthalmopathy differentiates it from the adult type of disease. Prolonged medical therapy is needed to induce good continued remission.
在1986年至1993年期间，有24名甲状腺功能亢进症患儿被转诊至我们处接受治疗。其中2名患有人为性甲状腺功能亢进症，1名患有毒性结节性甲状腺肿，另1名患有新生儿格雷夫斯病。20名患儿（6名男性，14名女性）患有格雷夫斯病。他们就诊时的年龄为10.86±2.02岁，症状持续时间从2.5个月至7年不等。神经精神症状，如多动、易怒、易兴奋和行为问题，是最常见的初始症状（90%）。18名患儿有不同程度的甲状腺肿大。85%的患儿有轻度或中度眼部受累，30%有心脏受累。血清游离甲状腺素和三碘甲状腺原氨酸水平升高，放射性碘摄取增加。所有患儿均接受甲巯咪唑，剂量为0.5 - 0.7mg/kg，分三次服用。一段时间后，17名患儿对治疗有反应，3名患儿无反应。停药后，6名有反应的患儿复发。儿童甲状腺功能亢进症较为罕见，一旦发生，几乎总是由格雷夫斯病引起。神经精神症状突出、起病隐匿且无严重浸润性眼病，使其有别于成人型疾病。需要长期药物治疗以实现良好的持续缓解。
