Selection of treatment in the management of thyrotoxicosis in childhood and adolescence.

The management of 105 patients between the ages of three and 18 years, 83 females and 22 males, with thyrotoxicosis was reviewed retrospectively (1952-1976) with the intent of identifying criteria that would help predict response to therapy with antithyroid drugs and thereby permit earlier selection of alternative treatment. All patients were initially treated with antithyroid drugs. Twenty-six per cent (27) achieved remission with thioamides, 68% (72) underwent subtotal thyroidectomy with three patients requiring subsequent therapy with radioiodine, 6% (6) received radioiodine with one patient subsequently requiring subtotal thyroidectomy. Failure of remission after thioamide therapy was related to drug toxicity, persistent disease, noncompliance and recurrence after an initial remission. During the last decade there was earlier selection of subtotal thyroidectomy based on prior experience. The most significant discriminants were sex, age, and regression of thyromegaly. Ninety-one per cent of the males, 89% of children over 11 years of age and all patients who had no regression of their thyromegaly after a sustained period of control of their thyrotoxicosis by thioamide therapy received subtotal thyroidectomy or radioiodine therapy for control of their thyrotoxicosis. Recognition of these factors at the time of diagnosis should permit earlier selection of the most suitable treatment and expedite patient care. Subtotal thyroidectomy has a low morbidity and is effective treatment for thyrotoxicosis in adolescence and childhood.