Enfermedad de Graves-Basedow en la infancia y la adolescencia: aspectos clinicobiológicos en 49 casos

Pavía Sesma, C.; Villanueva Lamas, J.; Torres Lacruz, M.; Valls Tolosa, C.; Rodríguez Hierro, F.

doi:10.1016/S1695-4033(00)77405-4

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Fundamento

La enfermedad de Graves-Basedow es rara en la infancia y la adolescencia.

Pacientes y método

Se han evaluado 6 niños y 43 niñas, con edades comprendidas entre 2 y 18 años. Todos presentaban un bocio difuso y sintomatología de hipertiroidismo. Las concentraciones de T4, FT4, T3 y TSH se determinaron por radioinmunoanálisis con diferente sensibilidad a lo largo del tiempo y los anticuerpos, por hemaglutinación. Todos fueron tratados con fármacos antitiroideos.

Resultados

En 5 casos se detectó un aumento de la velocidad de crecimiento y en otros 5 había una asociación con otras autoinmunopatías. El índice de Quetelet estaba entre los percentiles 90 y 97 en 5 casos, y entre 3 y 10 en 8 casos. Los resultados bioquímicos fueron: T4 282,41 ± 1,1 nmol/l; FT4 62,98 ± 1,1 pmol/l; T3 4,92 ± 0,07 nmol/l; TSH 0,002 mU/l. Los valores de TSI/TRAb fueron 33,23 ± 1,95 U/l. Sehan obtenido 4 remisiones totales y una parcial. En 4 ocasionesse recurrió a cirugía y 8 pacientes recibieron 131I.

Conclusiones

Se han obtenido pocas remisiones con el tratamiento médico y el radioyodo parece ser una terapéutica alternativa.

Palabras clave:

Hipertiroidismo

Graves-Basedow

Radioyodo

Background and objective

Graves' disease is rare in childhood and adolescence.

Patients and method

Six boys and 43 girls between the ages of 2 and 18 years were evaluated. All presented diffuse goiter and symptomatology of hyperthyroidism. Concentrations of T4, FT4, T3 and TSH were determined by RIA with various sensitivities during the study. Thyroid antibodies were determined by hemagglutination. All patients were treated with antithyroid drugs.

Results

In five patients, growth velocity increased. In a further five patients association with other autoimmune diseases was detected. Quetelet's index was between the 90th and 97th percentiles in five patients and between 3th and 10th in eight. Biochemical results were as follows: T4: 282.41 ± 1.1 nmol/1; FT4: 62.98 ± 1.1 pmol/l; T3: 4.92 ±0.07 nmol/l) and TSH: > 0.002-0.001 mU/l. Values of TSI/TRAb were 33.23 ± 1.95 U/l. Four total remissions and 1 partial remission were observed. Four patients underwent surgery and eight received radioiodine.

Conclusions

Few remissions were obtained with medical treatment.Radioiodine seems to be a therapeutic alternative.

Key words:

Hyperthyroidism

Graves' disease

Radioiodine

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Bibliografía

[1.]

P.G. Walfish, K.H. Tseng.

Thyroid physiology and pathology.

Pediatric endocrinology, pp. 367

[2.]

A. Grütters.

Treatment of Graves' disease in children and adolescents.

Horm Res, 49 (1993), pp. 255-257

Medline

[3.]

J.M. Tanner, R.H. Whithouse.

Clinical longitudinal standards for height, weight, height velocity, weight velocity and stages of puberty.

Arch Dis Child, 51 (1976), pp. 170-179

Medline

[4.]

H. Perrild, A. Grütters, U. Feldt, D. Grant, E. Martino, L. Kayser, et al.

Diagnosis and treatment of thyrotoxicosis in childhood. A European questionnaire study.

Eur J Endocrinol, 131 (1994), pp. 467-473

Medline

[5.]

M. Sempé, G. Pédron, M.P. Roy-Pernot.

Théraplix, (1979),

[6.]

M. Sempé, C. Pavía.

íaz de Santos, (1994),

[7.]

M.F. Rolland-Cachera, M. Sempé, M. Guillaud-Bataille, E. Patois, F. Péguinot-Guggenbuhl, V. Fautrad.

Adiposity indices in children.

Am J Clin Nutr, 36 (1982), pp. 178-184

Medline

[8.]

J. Boiko, J. Léger, M.C. Raux-Demay, S. Cabrol, Y. LeBouc, P. Czerni-Chow.

Maladie de Basedow chez l'enfant: aspects cliniques et évolutifs.

Arch Pédiatr, 5 (1998), pp. 722-730

Medline

[9.]

H. Barnes, R.M. Blizzard.

Antithyroid drug therapy for toxic diffuse goiter (Graves' disease): thirty years experience in children and adolescents.

J Pediatr, 91 (1977), pp. 313-320

Medline

[10.]

J.M. Friedman, P.J. Fialkow.

The genetics of Graves' disease.

J Clin Endocrinol Metab, 7 (1978), pp. 47-65

http://dx.doi.org/10.1210/jcem-7-1-47 | Medline

[11.]

E.H. Sidibe, M. Dia, H. Toure-Sow, A.M. Sow, S.M. Seck-Gassama, R. Ndoye.

Hyperthyroidism and diabetes mellitus: analysis of 10 african cases.

Ann Endocrinol (Paris), 60 (1999), pp. 33-39

[12.]

K. Yoshioka, A. Ohsawa, T. Yoshida, S. Yokoh.

Insulindependent diabetes mellitus associated with Graves' disease and idiopathic hypoparathyroidism.

J Endocrinol Invest, 16 (1993), pp. 643-646

http://dx.doi.org/10.1007/BF03347687 | Medline

[13.]

S. La Franchi, S. Mandel.

Graves' disease and other forms of hyperthyroidism in infants and children.

Curr Opin Endocrinol Diabetes, 3 (1996), pp. 101-109

[14.]

S. Schlesinger, M.H. McGillivary, R.W. Munschauer.

Acceleration of growth and bone maturation in childhood thyrotoxicosis.

J Pediatr, 83 (1973), pp. 233-236

Medline

[15.]

A. Siddiqi, J.M. Burrin, K. Noonan, I. James, D.F. Wood, C.P. Price.

A longitudinal study of markers of bone turnover in Graves' disease and their value in predicting bone mineral density.

J Clin Endocrinol Metab, 82 (1997), pp. 753-759

http://dx.doi.org/10.1210/jcem.82.3.3804 | Medline

[16.]

E. Jódar, M. Muñoz-Torres, F. Escobar-Jiménez, M. Quesada, J.D. Luna, N. Olea.

Antiresorptive therapy in hyperthyroid patients: longitudinal changes in bone and mineral metabolism.

J Clin Endocrinol Metab, 82 (1997), pp. 1989-1994

http://dx.doi.org/10.1210/jcem.82.6.4026 | Medline

[17.]

J.L. Kraimps, M.H. Bouin-Pineau, R. Marechaud, J. Barbier.

Basedow's disease and thyroid nodules. A common association.

Ann Chir, 52 (1998), pp. 449-451

Medline

[18.]

N.E. Carnell, W.A. Valente.

Thyroid nodules in Graves' disease: classification, characterization, and response to treatment.

Thyroid, 8 (1998), pp. 647-652

http://dx.doi.org/10.1089/thy.1998.8.647 | Medline

[19.]

G. Pellegreti, A. Belfiore, D. Giufrida, L. Lupo, R. Vigneri.

Outcome of differentiated thyroid cancer in Graves' patients.

J Clin Endocrinol Metab, 83 (1998), pp. 2805-2809

http://dx.doi.org/10.1210/jcem.83.8.4997 | Medline

[20.]

J.A. Franklyn.

The management of hyperthyroidism.

N Engl J Med, 330 (1994), pp. 1751-1758

[21.]

A. Grütters.

Treatment of Graves' disease in children and adolescents.

Horm Res, 49 (1998), pp. 255-257

Medline

[22.]

T.D. Cheetham, I.A. Hughes, N.D. Barnes.

Treatment of hyperthyroidism in young people.

Arch Dis Child, 78 (1998), pp. 207-209

Medline

[23.]

K.V. Williams, S. Nayak, D. Becker, J. Reyes, L.A. Burmeister.

Fifty years of experience with propylthiouracil-associated hepatotoxicity: what have we learnedα.

J Clin Endocrinol Metab, 82 (1997), pp. 1727-1733

http://dx.doi.org/10.1210/jcem.82.6.4011 | Medline

[24.]

C. Pavía, M.R. Martín, C. Valls, A. Palou.

Enfermedad de Graves-Basedow en la infancia: a propósito de un caso tratado con Enfermedad de Graves-Basedow en la infancia: a propósito de un caso tratado con carbonato de litio.

An Esp Pediatr, 13 (1980), pp. 1045-1046

Medline

[25.]

C.A. Benbassat, M.E. Molitch.

The use of lithium in the treatment of hyperthyroidism.

Endocrinologist, 8 (1998), pp. 383-387

[26.]

K. Hashizume, K. Ichikawa, A. Sakurai.

Administration of thyroxine in treated Graves' disease: effects on the level of antibodies to thyroid-stimulating hormone receptors and on the risk of recurrence of hyperthyroidism.

N Engl J Med, 324 (1991), pp. 947-953

http://dx.doi.org/10.1056/NEJM199104043241403 | Medline

[27.]

B. McIver, P. Rae, G. Beckett, E. Wilkinson, A. Gold, A. Toft.

Lack of effect of thyroxine in patients with Graves' hyperthyroidism who are treated with an antithyroid drug.

N Engl J Med, 334 (1996), pp. 220-224

http://dx.doi.org/10.1056/NEJM199601253340403 | Medline

[28.]

C. Gorton, A. Sadeghi-Nejad, B. Senior.

Remission in children with hyperthyroidism treated with propylthiouracil.

Ajdc, 141 (1987), pp. 1084-1086

Medline

[29.]

F.A. Karlsson.

Childhood Graves' disease-remission rate and risk factors.

J Clin Endocrinol Metabol, 83 (1998), pp. 1398

[30.]

N.S. Glaser, D.M. Styne.

Predictors of early remission of hyperthyroidism in children.

J Clin Endocrinol Metab, 82 (1997), pp. 1719-1726

http://dx.doi.org/10.1210/jcem.82.6.3986 | Medline

[31.]

R.S. Rittmaster, E.C. Abbott, R. Douglas, M.L. Givner, L. Lehman, S. Reddy.

Effect of methimazole, with or without L-thyroxine,on remission rates in Graves' disease.

J Clin Endocrinol Metab, 83 (1998), pp. 814-818

http://dx.doi.org/10.1210/jcem.83.3.4613 | Medline

[32.]

O. Torring, L. Tallstedt, G. Wallin, G. Lundell, J.G. Ljunggren, A. Taube, M. Saaf, B. Hamberger.

and the Thyroid Study Group. Graves' hyperthyroidism; treatment with antithyroid drugs, surgery, or radioiodine: a prospective, randomized study.

J Clin Endocrinol Metab, 81 (1996), pp. 2986-2993

http://dx.doi.org/10.1210/jcem.81.8.8768863 | Medline

[33.]

C. Rudberg, H. Johansson, G. Akerström, T. Tuvemo, F.A. Karlsson.

Graves' disease in children and adolescents. Late results of surgical treatment.

Eur J Endocrinol, 134 (1996), pp. 710-715

Medline

[34.]

L. Wartofsky.

Radioiodine in the treatment of Graves' disease.

Curr Opin Endocrinol Diabetes, 5 (1998), pp. 288-295

[35.]

T.D. Cheetman, P. Wraight, I. Hughes, N.D. Barnes.

Radioiodine treatment of Graves' disease in young people.

Horm Res, 49 (1998), pp. 258-262

Medline

[36.]

J.H. Lazarus.

Guideliness for the use of radioiodine in the management of hyperthyroidism: a summary.

J R Coll Phys(Londres), 29 (1995), pp. 464-469

[37.]

R.E. Imseis, L. Vanmiddlesworth, J.D. Massie, A.J. Bush, N.R. Vanmiddlesworth.

Pretreatment with propylthiouracil but not methimazole reduces the therapeutic efficacy of Iodine-131in hyperthyroidism.

J Clin Endocrinol Metab, 83 (1998), pp. 685-687

http://dx.doi.org/10.1210/jcem.83.2.4538 | Medline

[38.]

E. Vilardell.

Tratamiento del hipertiroidismo con yodo 131:riesgo-beneficio.

Endocrinología, 46 (1999), pp. 147-149

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