Treatment of hyperthyroidism in young people

Graves’ disease is rare in childhood but occurs with increasing frequency into adolescence and young adult life. There is a strong familial predisposition but the precipitating cause is not known. Stimulation of the thyroid stimulating hormone (TSH) receptor by autoantibodies causes excessive thyroid hormone production and secretion, and diffuse enlargement of the thyroid. Other systems may be involved, notably the eyes with proptosis. In children the early symptoms of hyperthyroidism are non-specific and may be of gradual onset; unless there is an obvious goitre, a psychological or behavioural disorder is often suspected. Once considered, the diagnosis is readily confirmed biochemically by raised concentrations of circulating thyroid hormones and suppression of TSH. The aim of treatment is to restore and maintain permanent euthyroidism as safely, quickly, and conveniently as possible. Especially in young people, there is no consensus on how this is best achieved and in this annotation we shall consider the options. The symptoms of hyperthyroidism may be distressing and can be relieved promptly to a great extent by blocking the peripheral effects of the excess thyroid hormones. A β blocking agent such as propranolol, 1 mg/kg/day in divided doses, is effective and useful to tide the patient over until the disease is controlled. An antithyroid drug can be started at the same time. The thionamide drugs block the synthesis of thyroid hormones and also have ill understood immunosuppressive effects in Graves’ disease.1Carbimazole is more widely used in Europe and propylthiouracil in the United States; although their actions and side effect profiles are slightly different, in practice they are interchangeable. Carbimazole 0.5 to 1.0 mg/kg/day or propylthiouracil 5 to 10 mg/kg/day in divided doses brings the hyperthyroidism of Graves’ disease under control in four to eight weeks. If there is urgent need to cure the disease as soon …