Autoimmune hyperthyroidism in children & adolescents in Sudan: a 13 years’ experience of a Paediatric Endocrinology Clinic
-
Ghassan Faisal Fadlalbari
,
Renson O. Mukhwana
Abstract
Background
Little has been published about hyperthyroidism in children from Sudan or Africa. In limited resource countries, lack of facilities and sociocultural factors might make international diagnosis and management guidelines difficult to follow. We aimed to determine the magnitude of autoimmune hyperthyroidism, clinical presentation, diagnosis, management and its outcome in Sudan.
Method
Records of all patients diagnosed as Graves’ disease (GD) or Hashitoxicosis (HTx) were reviewed and missing data filled by interviewing patients and/or their families. Data including age, sex, clinical presentation, investigations, management and outcome were obtained.
Results
Eighty-eight patients, 80 with GD (F:M = 4.7:1) and 8 with HTx (F:M = 7:1), were diagnosed at 11.8 ± 3.05 and 11.23 ± 2.78 years, respectively (p = 0.52). GD patients were diagnosed based on presence of exophthalmos (66.25%), positive thyroid receptor autoantibodies (12.5%), prolonged illness duration (8.75%) or remission failure to only B blocker (16.25%). All GD patients were started on carbimazole and cumulative remission rate was 11.8%, 32.4% and 41.2% by end of the second, third and fourth year respectively, however it plateaus after that. While 12 GD patients underwent surgery, only three opted for radioiodine ablation.
Conclusion
Hyperthyroidism is not an uncommon problem. In absence of laboratory facilities, differentiation between GD and HTx can be made based on clinical grounds. Continuation of medical treatment for 4 years can increase the remission rate to 41.2%. In Sudan, surgery is the preferred method of definitive therapy.
Funding source: European Society for Paediatric Endocrinology
Acknowledgment
Authors would like to thank Dr. Amna Ismail Bushara, Mr. Mutassim Fadol and medical records officers at Gafar Ibn Auf Hospital for the great help in data collection.
Research funding: This study was sponsored by European Society for Paediatric Endocrinology (ESPE).
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the ethical committee of the hospital.
References
1. Wasniewska, M, Corrias, A, Salerno, M, Lombardo, F, Aversa, T, Mussa, A, et al. Outcomes of children with hashitoxicosis. Horm Res Paediatr 2012;77:36–40. https://doi.org/10.1159/000334640.Search in Google Scholar
2. Bauer, AJ. Approach to the pediatric patient with Graves’ disease: when is definitive therapy warranted? J Clin Endocrinol Metab 2011;96:580–8. https://doi.org/10.1210/jc.2010-0898.Search in Google Scholar
3. Kourime, M, McGowan, S, Al Towati, M, Ahmed, SF, Stewart, G, Williamson, S, et al. Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland: the case for long-term antithyroid treatment and the importance of initial counselling. Arch Dis Child 2018;103:637–42. https://doi.org/10.1136/archdischild-2017-313454.Search in Google Scholar
4. Huang, SA. Thyroid. In: Kappy, MS, Allen, DB, Geffner, ME, editors. Thyrotoxicosis. New York: McGraw-Hill; 2010: pp. 119–122.10.1007/978-0-387-32322-0_3Search in Google Scholar
5. Corrias, A, Cassio, A, Weber, G, Mussa, A, Wasniewska, M, Rapa, A, et al. Thyroid nodules and cancer in children and adolescents affected by autoimmune thyroiditis. Arch Pediatr Adolesc Med 2008;162:526–31. https://doi.org/10.1001/archpedi.162.6.526.Search in Google Scholar
6. Ross, DS, Burch, HB, Cooper, DS, Greenlee, MC, Lauberg, P, Maia, AL, et al. American thyroid association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016;26:1343–421. https://doi.org/10.1089/thy.2016.0229.Search in Google Scholar
7. Jevalikar, G, Solis, H, Zacharin, M. Long-term outcomes of pediatric Graves’ disease. J Pediatr Endocrinol Metab 2014;27:1131–6. https://doi.org/10.1515/jpem-2013-0342.Search in Google Scholar
8. Rabon, S, Burton, AM, White, PC. Graves’ disease in children: long-term outcomes of medical therapy. Clin Endocrinol 2016;85:632–5. https://doi.org/10.1111/cen.13099.Search in Google Scholar
9. Ohye, H, Minagawa, A, Noh, JY, Mukasa, K, Kunii, Y, Watanabe, N, et al. Antithyroid drug treatment for Graves’ disease in children: a long-term retrospective study at a single institution. Thyroid 2014;24:200–7. https://doi.org/10.1089/thy.2012.0612.Search in Google Scholar
10. Léger, J, Gelwane, G, Kaguelidou, F, Benmerad, M, Alberti, C, French Childhood Graves’ Disease Study Group. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves’ disease: national long-term cohort study. J Clin Endocrinol Metab 2012;97:110–9. https://doi.org/10.1210/jc.2011-1944.Search in Google Scholar
11. World Health Organization, International Council for Control of Iodine Deficiency Disorder. Indicators for assessing iodine deficiency disorders and their control through salt iodization. World Health Organization; 1994.Search in Google Scholar
12. Effraimidis, G, Wiersinga, WM. Autoimmune thyroid disease: old and new players. Eur J Endocrinol 2014;170:R241–52. https://doi.org/10.1530/eje-14-0047.Search in Google Scholar
13. Sanyal, D, Chatterjee, S. Hyperthyroidism in children: treatment outcomes and preferences in Eastern India. Clin Pediatr Endocrinol 2015;24:63–6. https://doi.org/10.1297/cpe.24.63.Search in Google Scholar
14. Jaja, T, Yarhere, IE. Clinical characteristics of children and adolescents with thyroid disorders seen at the University of Port Harcourt Teaching Hospital: a five year review. Niger J Paediatr 2014;41:302–6. https://doi.org/10.4314/njp.v41i4.2.Search in Google Scholar
15. Sidibe, AT, Dembele, M, Diarra, AS, Bocoum, AL, Mousseni, E, Ag, SA, et al. Hyperthyroidism in children. Experience in internal medicine in Mali. Ann Endocrinol 2007;68:177–80. https://doi.org/10.1016/j.ando.2007.05.003.Search in Google Scholar
16. Niang, B, Thiam, L, Ly, F, Ly, ID, Boiro, D, Sow, A, et al. Evolutionary profile of Graves’ disease in children at Albert Royer National Children Hospital in Dakar. Open J Pediatr 2019;9:119. https://doi.org/10.4236/ojped.2019.92012.Search in Google Scholar
17. Cárdenas-Roldán, J, Rojas-Villarraga, A, Anaya, JM. How do autoimmune diseases cluster in families? A systematic review and meta-analysis. BMC Med 2013;11:73. https://doi.org/10.1186/1741-7015-11-73.Search in Google Scholar
18. De Luca, F, Corrias, A, Salerno, M, Wasniewska, M, Gastaldi, R, Cassio, A, et al. Peculiarities of Graves’ disease in children and adolescents with Down’s syndrome. Eur J Endocrinol 2010;162:591–5. https://doi.org/10.1530/eje-09-0751.Search in Google Scholar
19. Osman, KM. Graves’ disease frequency and clinical pattern in Khartoum teaching Hospital January-July 2004 [Doctoral dissertation]. University of Khartoum.Search in Google Scholar
20. Elmugadam, A, Elobied, E, Mustafa, H, Elfadil, G, Makeen, A. Anti-TPO and Anti-Tg antibodies in Sudanese patients with thyroid diseases and association of HLA Class-II with Graves’ disease. J Am Sci 2014;10:39–42.Search in Google Scholar
21. Lee, JH, Park, SH, Koh, DG, Suh, BK. Thyroid peroxidase antibody and triiodothyronine levels are associated with pediatric Graves’ ophthalmopathy. World J Pediatr 2014;10:155–9. https://doi.org/10.1007/s12519-014-0476-y.Search in Google Scholar
22. Jiang, Y, Hu, K, Xie, W, Zheng, G, Sun, J, Zheng, Y, et al. Hyperthyroidism with concurrent FMS-like tyrosine kinase 3-internal tandem duplication-positive acute promyelocytic leukemia: a case report and review of the literature. Oncol Lett 2014;7:419–22. https://doi.org/10.3892/ol.2013.1721.Search in Google Scholar
23. Miulescu, R, Carşote, M, Trifănescu, R, Foreside, D, Poiană, C. Antithyroid drugs induced agranulocytosis and multiple myeloma: case report and general considerations. J Med Life 2013;6:327.Search in Google Scholar
24. Rivkees, SA. Controversies in the management of Graves’ disease in children. J Endocrinol Investig 2016;39:1247–57. https://doi.org/10.1007/s40618-016-0477-x.Search in Google Scholar
25. Weetman, AP. Graves’ hyperthyroidism: how long should antithyroid drug therapy be continued to achieve remission? Nat Clin Pract Endocrinol Metab 2006;2:2–3. https://doi.org/10.1038/ncpendmet0068.Search in Google Scholar
26. Glaser, NS, Styne, DM: Predictors of early remission of hyperthyroidism in children. J Clin Endocrinol Metab 1997;82:1719–26. https://doi.org/10.1210/jc.82.6.1719.Search in Google Scholar
27. Azizi, F, Takyar, M, Madreseh, E, Amouzegar, A. Long term methimazole therapy in Juvenile Graves’ disease: a randomized trial. Pediatrics 2019;143:e20183034. https://doi.org/10.1542/peds.2018-3034.Search in Google Scholar
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review Articles
- Definition and early diagnosis of metabolic syndrome in children
- Cystic fibrosis-related diabetes: an update on pathophysiology, diagnosis, and treatment
- Original Articles
- Association of sleep characteristics with adiposity markers in children
- Prevalence of abdominal obesity in non-obese adolescents: a North Indian adolescent study
- Utility of estimated glucose disposal rate for predicting metabolic syndrome in children and adolescents with type-1 diabetes
- Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes
- Association between eating behavior, anthropometric and biochemical measurements, and peptide YY (PYY) hormone levels in obese adolescents in outpatient care
- Autoimmune hyperthyroidism in children & adolescents in Sudan: a 13 years’ experience of a Paediatric Endocrinology Clinic
- Timing, prevalence, and dynamics of thyroid disorders in children and adolescents affected with Down syndrome
- Assessment of the most common CYP21A2 point mutations in a cohort of congenital adrenal hyperplasia patients from Egypt
- Quality of life and associated factors in parents of children with late diagnosed phenylketonuria. A cross sectional study in a developing country (Tunisia)
- Genetic analysis and long-term treatment monitoring of 11 children with glycogen storage disease type IIIa
- Growth and metabolic effects of long-term recombinant human growth hormone (rhGH) treatment in short children born small for gestational age: GH-RAST study
- Menstrual cycle, reproductive function, body mass index, and metabolic profiles of women with former central precocious puberty: 10–20-year longitudinal cohort study in southern Thailand
- Letter to the Editors
- European Society of Paediatric Radiology (ESPR) Child Abuse Taskforce Committee: a response to Miller et al.
- The correct formula to calculate triglyceride-glucose index (TyG)
- Case Reports
- Octreotide-related exocrine pancreatic insufficiency (EPI) in congenital hyperinsulinism
- Improvement in glycaemic parameters using SGLT-2 inhibitor and GLP-1 agonist in combination in an adolescent with diabetes mellitus and Prader-Willi syndrome: a case report
- Three patients with glucose-6 phosphatase catalytic subunit 3 deficiency
- Efficacy and safety of denosumab treatment in a prepubertal patient with cherubism
Articles in the same Issue
- Frontmatter
- Review Articles
- Definition and early diagnosis of metabolic syndrome in children
- Cystic fibrosis-related diabetes: an update on pathophysiology, diagnosis, and treatment
- Original Articles
- Association of sleep characteristics with adiposity markers in children
- Prevalence of abdominal obesity in non-obese adolescents: a North Indian adolescent study
- Utility of estimated glucose disposal rate for predicting metabolic syndrome in children and adolescents with type-1 diabetes
- Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes
- Association between eating behavior, anthropometric and biochemical measurements, and peptide YY (PYY) hormone levels in obese adolescents in outpatient care
- Autoimmune hyperthyroidism in children & adolescents in Sudan: a 13 years’ experience of a Paediatric Endocrinology Clinic
- Timing, prevalence, and dynamics of thyroid disorders in children and adolescents affected with Down syndrome
- Assessment of the most common CYP21A2 point mutations in a cohort of congenital adrenal hyperplasia patients from Egypt
- Quality of life and associated factors in parents of children with late diagnosed phenylketonuria. A cross sectional study in a developing country (Tunisia)
- Genetic analysis and long-term treatment monitoring of 11 children with glycogen storage disease type IIIa
- Growth and metabolic effects of long-term recombinant human growth hormone (rhGH) treatment in short children born small for gestational age: GH-RAST study
- Menstrual cycle, reproductive function, body mass index, and metabolic profiles of women with former central precocious puberty: 10–20-year longitudinal cohort study in southern Thailand
- Letter to the Editors
- European Society of Paediatric Radiology (ESPR) Child Abuse Taskforce Committee: a response to Miller et al.
- The correct formula to calculate triglyceride-glucose index (TyG)
- Case Reports
- Octreotide-related exocrine pancreatic insufficiency (EPI) in congenital hyperinsulinism
- Improvement in glycaemic parameters using SGLT-2 inhibitor and GLP-1 agonist in combination in an adolescent with diabetes mellitus and Prader-Willi syndrome: a case report
- Three patients with glucose-6 phosphatase catalytic subunit 3 deficiency
- Efficacy and safety of denosumab treatment in a prepubertal patient with cherubism
