Frequency, etiology and treatment of hyperthyroidism in children and adolescents at the Department of Pediatrics of the UHC Zagreb from 2001 to 2016

Cilj ovog retrospektivnog deskriptivnog istraživanja bio je ispitati učestalost pojedinih uzroka hipertireoze te načine i uspješnost liječenja hipertireoze u skupine bolesnika liječenih u Zavodu za endokrinologiju i dijabetes Klinike za pedijatriju Kliničkog bolničkog centra Zagreb, u razdoblju od 1. siječnja 2001. godine do 31. prosinca 2016. godine. Ispitivanu skupinu činilo je 78 bolesnika, od toga 56 djevojčica i 22 dječaka (♀:♂ =2,5:1) u dobi od 5 do 22 godine. U najvećeg broja bolesnika, njih 71, hipertireoza je bila uzrokovana Gravesovom bolešću. U preostalih bolesnika uzroci hipertireoze su bili toksični adenom, autoimuna bolest štitnjače s izmjenjujućom pojavom („switching“-om) stimulirajućih i blokirajućih autoantitijela i amiodaronska hipertireoza tip II. Najveća učestalost hipertireoze utvrđena je u djevojčica u dobnoj skupini od 10-14 godina. Svi bolesnici oboljeli od Gravesove bolesti inicijalno su liječeni medikamentozno. U 16/43 (37%) bolesnika remisija je postignuta nakon inicijalne medikamentozne terapije prosječnog trajanja 35,6 mjeseci (raspon od 2–90 mjeseci). Relaps nakon medikamentozne terapije javio se u 27/43 (63%) bolesnika nakon čega je 13/43 (30%) bolesnika s višestrukim relapsima upućeno na operativni zahvat, u 2/43 (5%) bolesnika primijenjena je terapija radioaktivnim jodom, a u 12/43 (28%) bolesnika nastavljena je medikamentozna terapija. Rezultati naše studije slični su rezultatima u ostalim europskim zemljama u kojima je medikamentozna terapija također prvi izbor u liječenju Gravesove bolesti. Međutim, za razliku od SAD-a te drugih zemalja u kojima je metoda izbora RAI, vodeći modalitet liječenja Gravesove bolesti u bolesnika u kojih nije uspostavljena medikamentozna remisija u našoj ustanovi je totalna tiroidektomija. U 17 bolesnika uz hipertireozu nađene su i pridružene autoimune bolesti i genetski poremećaji: vitiligo, šećerna bolest tip 1, Wolff-Parkinson-Whiteov sindrom, sistemski eritematozni lupus, Downov i DiGeorgov sindrom.The aim of this retrospective descriptive study was to investigate the etiology, frequency and treatment modalities in pediatric patients with hyperthyroidism treated in the University Hospital Centre Zagreb at the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes in the period from January 2001 to December 2016. The study included 78 patients, comprising 56 girls and 22 boys (♀:♂ = 2,5:1) aged 5 to 22 years. The most common cause of hyperthyroidism was Graves' disease, which was diagnosed in 71 patients. Other causes of hyperthyroidism were toxic adenoma, autoimmune thyroid disease with switching stimulating and blocking autoantibodies, and amiodarone-induced thyrotoxicosis type II. An incidence peak was noticed in girls aged 10-14 years, which corresponds to the results of similar studies in other European countries. All patients with Graves’ disease were initially treated with antithyroid drugs. Among them, 16/43 (37%) achieved remission after using antithyroid drugs. Relapse after initial therapy with antithyroid drugs was reported in 27/43 (63%) patients. Radioiodine therapy was used in 2/43 (5%) patients with Graves’ disease, whereas 13/43 (30%) patients underwent surgical operation. The results of our study correspond to results in other European countries, where antithyroid drugs are also initial treatment option. However, there is a significant difference in the choice of the ultimate modality of Graves’ disease treatment. Our results demonstrate preference of surgery over RAI which is increasingly opted for in other European and world countries. The presence of other autoimmune and genetic diseases was noticed in 17 patients with hyperthyroidism, such as vitiligo, type 1 diabetes mellitus, Wolff-Parkinson-White syndrome, systemic erythematous lupus, Down's syndrome and DiGeorge syndrome