Introduction

Thyrotoxicosis is a relatively uncommon disorder in childhood and adolescence. The BPSU
survey found an incidence of 0.94 per 100,000 <15yr olds. ¹

Most patients with thyrotoxicosis have Graves’ disease (84% in the BPSU study) which develops because of
thyrotropin (TSH) receptor stimulation by auto antibodies. Patients with Hashimoto’s thyroiditis can also be thyrotoxic in the early phase of the disease (12 % of cases in BPSU study). Other causes of thyrotoxicosis are much rarer.

In a child with typical features of thyrotoxicosis (see tables 1,2), the diagnosis is confirmed with a suppressed TSH and raised thyroid hormone levels (either T4 or T3 or both).

Children and adolescents presenting with autoimmune thyrotoxicosis in the UK and throughout Europe are usually treated with antithyroid drugs from diagnosis for 1 - 4 years. ^1,2 Treatment is then stopped and patients who relapse return to anti-thyroid drugs or are offered more definitive treatment with surgery or radioiodine. This practice differs from common practice in the USA where there are strong proponents of early use of radioiodine therapy.⁴ Other centres may also promote the early use of thyroid surgery as a definitive
treatment.

None of these therapies are ideal and each have their own advantages and disadvantages. Particular considerations when managing young people include:

• The high relapse rates following a course of anti-thyroid drug therapy.^5,6 
• Concerns about the morbidity associated with thyroidectomy.
• Concerns about the long term safety of radioiodine.