Conservative strategies in treating thyroid diseases in children
Homoki, J.; Teller, W.M.
Monatsschrift Kinderheilkunde Organ der Deutschen Gesellschaft für Kinderheilkunde 138(3): 115-120
1990
ISSN/ISBN: 0026-9298 PMID: 2191216 Document Number: 3944
In the Federal Republic of Germany disorders of the thyroid gland are among the most common chronic diseases of childhood and adolescence. In Munich 30% of schoolchildren, in Göttingen 16% of children 6 to 16 years of age have goiters. Iodine deficiency is the most important etiological reason for the development of euthyroid goiter, which is encountered in more than 80% of children and adolescents suffering from thyroid disorders. Lymphocytic chronic thyroiditis (Hashimoto) causes goiters which may be eu-, hypo- but also hyperthyroid. Thyrotoxicosis (M. Basedow, Grave's Disease) in childhood occurs mainly in pubertal girls. The frequency of tongenital hypolhyroidism in West Germany is 1:3,800 neonates. The postnatally acquired hypothyroidism in childhood is as rare as hyperthyroidism caused by toxic thyroid adenoma. 27% of nodular goiters in childhood are due to Thyroid carcinoma. The diagnostic procedure of evaluation of thyroid disorders in childhood includes family and past personal history, palpatory findings, ultrasonography and the determination of TSH and thyroid hormone plasma concentrations. The aims of conservative management of thyroid diseases during childhood and adolescence are 1st normalisation of size of the thyroid gland, 2nd achievement and maintenance of euthyroid function. The conservative treatment of the most common thyroid diseases during childhood and adolescence consists of: euthyroid diffuse goiter: 100-200 lig iodine per day or 100-125 pg 1-thyroxine/m2/die or 100 lig iodine plus 100 lig 1-thyroxine orally; hyperthyroidism: 5-7 mg/kg bodyweight propylthiouracil or 0.3-0.7 mg/kg carbimazol/thiamazol per day or sodium perchlorate 10-20 mg/kg per day orally until euthyroidism is achieved; than gradual reduction of dose; hypothyroidism: 10-15 lig 1-thyroxine/kg per day orally until 6 months of age, 6-8 Kg 1-thyroxine/kg per day orally until 12 months. Thereafter 100-150 µg/m2 body surface per day 1-thyroxine orally life long. Prophylaxis of iodine deficiency for prevention of euthyreot goiter during childhood: iodized salt + 100 lag iodine per day orally.
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