A descriptive analysis of children and adolescents with Graves disease attending the paediatric endocrinology services of the Red Cross War Memorial Children's Hospital and Groote Schuur Hospital over 20 years

Background Hyperthyroidism occurs in about 1 per 5000 children and adolescents. Graves disease (GD) is the most common cause of hyperthyroidism in children and adolescents. The treatments that are currently available for children with GD include Carbimazole (CMZ), radioactive iodine (RAI) therapy and surgery. The paucity of GD data in children from the sub-Saharan African region, challenge the physician in identifying the best suited diagnostic and treatment strategies for the patient population in their setting. Objective The aim was to describe the population group attending the Paediatric and Adolescent Endocrinology Services (PAES) at Red Cross War Memorial Children's Hospital (RCCH) and Groote Schuur Hospital (GSH) in Cape Town, Western Cape. This study hoped to contribute information to the body of evidence concerning GD in the paediatric population of South Africa. Methods This was a retrospective folder review of all children and adolescents diagnosed with GD, attending the PAES in the previous two decades. Their demographic profile, clinical and laboratory findings and the treatment modalities utilised were described. All patients diagnosed with GD between the ages of 1 and 20 years old were included. Data were described as proportions and percentages. The measures of central tendency were described by median, and inter-quartile range (IQR). Results Thirty-one patients were included in the study. Twenty-six patients were female. The median age at presentation was 10.1 years (IQR: 8.9; 11.7). All patients were initially treated medically with Carbimazole (CMZ). Two patients experienced mild adverse reactions attributed to CMZ. Twelve (39%) patients went into remission after a single course of CMZ, after a median of 16.3 months(IQR: 8.6; 35.1). At the study's conclusion, nine (29%) patients were in remission, nine (29%) remained on CMZ therapy, ten (32%) underwent RAI and three (10%) relapsed before GD remission was achieved. One-quarter of the patients (n=8) were known with Down syndrome (DS). These patients presented at a significantly younger age than those without DS. Conclusion The children and adolescents diagnosed with GD managed in the PAES were similar in sex distribution, slightly younger in age and tolerated CMZ better than reported in literature. This study demonstrated the importance of considering prolonging CMZ therapy in patients not yet in remission and as a viable retreatment option in patients that relapse.

Grantor

Department of Paediatrics and Child Health

Year dc:date.issued

2021

Author dc:creator

• Mendes, Jacqueline

Advisor dc:contributor.advisor

• Carrihill, Michelle

• Paediatric Endocrinology

Handle dc:identifier.uri

http://hdl.handle.net/11427/35929

OAI identifier oai:identifier

oai:open.uct.ac.za:11427/35929