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Jawwad M, Ahmed SA, Zaidi SMM, Fatmi SAA, Ashraf MH, Naeem S, Chola MS. Long-term outcome of treatments for Graves disease in the children and adolescent population. Endocrine 2023:10.1007/s12020-023-03371-1. [PMID: 37115377 DOI: 10.1007/s12020-023-03371-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Several studies were conducted over the years to find a significant association between non-surgical therapies such as Antithyroid Drug (ATD) Therapy and Radio-iodo therapy (RIT) with Graves' disease (GD) remission and relapse. However, these investigations did not have a specific focus on the age category of children and adolescents. Hence, this Research is performed to assess the association of non-surgical therapy (ATD and RIT) with Graves' disease (GD) remission and relapse in the children and adolescent population. DESIGN A systematic review and meta-analysis of observational studies and clinical trials were carried out. METHODS A systematic search of PubMed, EMBASE, and SCOPUS from their inception till April 2022 was performed for studies stating an association between ATD therapy and GD remission and relapse in participants 1-17 years old. The random-effects model was used in the meta-analysis to provide a pooled proportion of both primary outcomes. The quality and each study were assessed using the Newcastle Ottawa Scale (NOS). RESULT From 6195 studies searched from the databases, only 16 relevant articles remained after a detailed evaluation. These studies, having a total of 2557 patients aged 5-17 years, were involved in the analysis with a pooled estimate showing a significant association of ATD therapy with GD remission (Estimate: 0.400, 95% Confidence interval: 0.265-0.535; I^2 = 98.16%) and with GD relapse (Estimate: 0.359, 95% Confidence interval: 0.257-0.461; I^2 = 98.26%). Subgroup analyses were conducted to assess the remission rate of different therapies suggesting that antithyroid drugs play a significant role in the remission of the patients. All included studies were classified as moderate quality. CONCLUSION Following meta-analysis suggested that the ATD used in the analysis is effective in remitting GD in the children and adolescents population. Nevertheless, long-term RIT therapy and thyroidectomy leads to hypothyroidism. Still, large-sample, and high-quality studies targeting ATDs' use in children and adolescents with long-term surveillance of prognosis are needed.
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Affiliation(s)
- Mohammad Jawwad
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan.
| | - Syed Arsalan Ahmed
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan
| | | | - Syed Ashad Ahmed Fatmi
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan
| | - Muhammad Hasan Ashraf
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan
| | - Shozab Naeem
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan
| | - Muhammad Shuraim Chola
- Department of Medicine and Surgery, Dow University of Health and Sciences, Karachi, Pakistan
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2
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Evaluating the Role of Circulating Dendritic Cells in Methimazole-Treated Pediatric Graves' Disease Patients. Genes (Basel) 2021; 12:genes12020164. [PMID: 33530368 PMCID: PMC7911035 DOI: 10.3390/genes12020164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 02/06/2023] Open
Abstract
Graves’ disease (GD) is hyperthyroidism associated with organ-specific autoimmune inflammation. GD occurs more frequently in adults than in children; however, pediatric patients are a therapeutic challenge due to cycles of remissions and relapses requiring constant monitoring at every stage of treatment administered. Dendritic cells (DCs) are considered to be a link between innate and adaptive immunity. DCs, as antigen-presenting cells (APCs), are involved in antigen presentation to T lymphocytes, thereby initiating a shift towards effector cells. In accordance, DCs also participate in the modulation of tolerance to specific antigens. To date, the data on DCs’ role in Graves’ pathological processes are scarce. Therefore, here, we evaluated the frequencies and role of circulating DCs in GD pediatric patients treated with methimazole. Flow cytometric analysis was implemented to evaluate three subsets of dendritic cells and their correlation with clinical GD-related parameters. We found significantly higher levels of DC subsets in patients at diagnosis. Furthermore, methimazole treatment seemed to effectively reduce subsets of DCs, which, in addition, were found to differentially correlate with thyroid function. Our study shed new light on DCs’ role in the pediatric GD pathomechanism. Further studies are required for the mechanistic assessment of DCs’ exact role in disease progression and influence on thyroid function.
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Stożek K, Grubczak K, Marolda V, Eljaszewicz A, Moniuszko M, Bossowski A. Lower proportion of CD19+IL-10+ and CD19+CD24+CD27+ but not CD1d+CD5+CD19+CD24+CD27+ IL-10+ B cells in children with autoimmune thyroid diseases. Autoimmunity 2019; 53:46-55. [DOI: 10.1080/08916934.2019.1697690] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Karolina Stożek
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
| | - Kamil Grubczak
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Viviana Marolda
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Andrzej Eljaszewicz
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Marcin Moniuszko
- Department of Regenerative Medicine and Immune Regulation, Medical University of Bialystok, Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatric Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Bialystok, Poland
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4
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Zader SJ, Williams E, Buryk MA. Mental Health Conditions and Hyperthyroidism. Pediatrics 2019; 144:peds.2018-2874. [PMID: 31582535 DOI: 10.1542/peds.2018-2874] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2019] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the proportion of pediatric patients with concurrent diagnoses of hyperthyroidism and mental health conditions (MHCs) by using the Military Health System database. We hypothesized that the prevalence of mental health disorders would be higher in patients with hyperthyroidism compared with in the nonhyperthyroid population. METHODS The prevalence of hyperthyroidism and MHCs was calculated by using data extracted from the Military Health System Data Repository on military beneficiaries between 10 and 18 years old who were eligible to receive care for at least 1 month during fiscal years 2008 through 2016. Prevalence ratios were used to compare MHC diagnoses in those with versus without a diagnosis of hyperthyroidism. RESULTS There were 1894 female patients and 585 male patients diagnosed with hyperthyroidism during the study period. Prevalence ratios for MHCs in those with versus without hyperthyroidism ranged from 1.7 (attention-deficit/hyperactivity disorder [ADHD]) to 4.9 (bipolar disorder). Strikingly, suicidality was nearly 5 times more likely in patients diagnosed with hyperthyroidism than in patients who were never diagnosed with hyperthyroidism. For each of the MHCs examined, with the exception of suicidality, the MHC diagnosis was more commonly made before the diagnosis of hyperthyroidism, with the highest proportion of patients being diagnosed with ADHD before receiving a diagnosis of hyperthyroidism (68.3%). CONCLUSIONS There is a clear association between hyperthyroidism and each of the following MHCs: ADHD, adjustment disorder, anxiety, bipolar disorder, depression, and suicidality. This study highlights the need to consider this association when evaluating patients with overlapping symptoms and for effective mental health screening tools and resources for clinicians.
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Affiliation(s)
- Sarah J Zader
- Naval Medical Center Portsmouth, Portsmouth, Virginia.,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
| | - Ernest Williams
- Naval Medical Center Portsmouth, Portsmouth, Virginia.,Health Analysis Department, Navy and Marine Corps Public Health Center, Portsmouth, Virginia
| | - Melissa A Buryk
- Naval Medical Center Portsmouth, Portsmouth, Virginia; .,Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland; and
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5
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Rydzewska M, Michalak J, Bossowska A, Chen S, Black S, Powell M, Furmaniak J, Rees Smith B, Bossowski A. Analysis of diabetes-associated autoantibodies in children and adolescents with autoimmune thyroid diseases. J Pediatr Endocrinol Metab 2019; 32:355-361. [PMID: 30903759 DOI: 10.1515/jpem-2018-0367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 02/08/2019] [Indexed: 01/08/2023]
Abstract
Background Zinc transporter 8 autoantibodies (ZnT8Abs) together with glutamic acid decarboxylase autoantibodies (GADAbs), insulinoma antigen 2 autoantibodies (IA-2Abs) and insulin autoantibodies (IAbs) are markers of type 1 diabetes mellitus (T1DM). We studied the prevalence of ZnT8Ab in children with autoimmune thyroid diseases (AITDs) to assess the association of AITDs and T1DM at the serological level. Methods The study groups consisted of 44 children with Graves' disease (GD), 65 children with Hashimoto's thyroiditis (HT), 199 children with T1DM with or without AITDs and 58 control children. ZnT8Ab, GADAb, IA-2Ab, IAb, 21-hydroxylase autoantibodies (21-OHAbs) and acetylcholine receptor autoantibodies (AChRAbs) were measured. Results ZnT8Abs were found in 4/44 (9.1%) patients with GD, and 4/44 (9.1%) patients with GD were positive for GADAb. Of the 65 HT patients, six (9.2%) were positive for ZnT8Ab, while four (6.2%) were positive for GADAb. In the T1DM group, 128/199 (64%) of the patients were positive for ZnT8Ab, 133/199 (67%) for GADAb and 109/199 (55%) for IA-2Ab. One GD patient and one HT patient were positive for all the four diabetes-associated autoantibodies. Two HT patients were positive for three diabetes autoantibodies. Two GD (4.5%) and five HT (7.7%) patients were positive for 21-OHAb only. None of the patients had AChRAb. In the control group, 2/58 (3.4%) were positive for GADAb and 2/58 (3.4%) were positive for ZnT8Ab. Conclusions Diabetes-associated autoantibodies including ZnT8Ab were found in children and adolescents with GD and HT.
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Affiliation(s)
- Marta Rydzewska
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Justyna Michalak
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Bialystok, Białystok, Poland
| | - Anna Bossowska
- Division of Cardiology, Internal Affairs Ministry Hospital in Białystok, Białystok, Poland
| | - Shu Chen
- FIRS Laboratories, RSR Ltd, Cardiff, UK
| | | | | | | | | | - Artur Bossowski
- Department of Pediatrics, Endocrinology and Diabetes with a Cardiology Unit, Medical University of Białystok, ul. Waszyngtona 17, Białystok 15-274, Poland
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6
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Gill DS, Greening JE, Howlett TA, Levy MJ, Shenoy SD. Long-term outcome of hyperthyroidism diagnosed in childhood and adolescence: a single-centre experience. J Pediatr Endocrinol Metab 2019; 32:151-157. [PMID: 30685744 DOI: 10.1515/jpem-2018-0385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/02/2018] [Indexed: 11/15/2022]
Abstract
Background The objective of the study was to evaluate the long-term outcome of paediatric-onset hyperthyroidism with follow-up into adulthood and to identify any early predictors of a need for definitive therapy (DT). Methods In a retrospective analysis of patients diagnosed with hyperthyroidism under the age of 18 years and at follow-up, a comparison was made by categorising them into those who underwent definitive therapy (DT group), i.e. thyroidectomy/radioactive iodine (RAI), those who remained on antithyroid drugs (ATD) (CBZ group) and those who had complete remission (RE group). Results Sixty-one (49 females, 12 males) patients with a median age of 15.1 years (range: 3.6-18) at diagnosis were studied. The duration of the first course of ATD varied from <1 year (7%), 1-2 years (26%), >2 years (46%) and ATD never discontinued (21%). Disease relapsed in 69% of patients with <1 year of ATD vs. 79% with >2 years of ATD. At follow-up, the median duration since diagnosis was 8.75 years (range 2.0-20.7 years) and the median age at follow-up was 23.2 years (8-36 years). Thirty-three percent (20/61) had undergone DT (DT group) - with 16.5% (n=10) on RAI and 16.5% (n=10) on surgery, 36% (22/61) were on ATD (CBZ group), whilst 32% (19/61) had undergone full remission (RE group). The comparison did not identify any statistically significant difference for predictor factors at diagnosis including age, T4 and free T4 levels, thyroid peroxidise antibody levels (TPO) and the duration of the first course of carbimazole (CBZ) treatment. Conclusion Long-term complete remission of paediatric-onset hyperthyroidism in our study was 31%. There were no predictors identified that could help predict the long-term outcome, especially into adulthood.
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Affiliation(s)
- Daniel S Gill
- Paediatric Department, University Hospital of Leicester - Leicester Royal Infirmary, Leicester, UK
| | - James E Greening
- Paediatric Department, University Hospital of Leicester - Leicester Royal Infirmary, Leicester, UK
| | - Trevor A Howlett
- Endocrinology Department, Leicester Centre for Genetics, Endocrinology and Metabolism, Leicester Royal Infirmary, Leicester, UK
| | - Miles J Levy
- Endocrinology Department, Leicester Centre for Genetics, Endocrinology and Metabolism, Leicester Royal Infirmary, Leicester, UK
| | - Savitha D Shenoy
- Paediatric Department, University Hospital of Leicester - Leicester Royal Infirmary, Leicester, UK
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Veldscholte K, Barjaktarovic M, Trajanoska K, Jaddoe VWV, Visser TJ, de Rijke YB, Peeters RP, Rivadeneira F, Korevaar TIM. The Association of Thyroid Function With Bone Density During Childhood. J Clin Endocrinol Metab 2018; 103:4125-4134. [PMID: 30020476 DOI: 10.1210/jc.2018-00294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 07/12/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT Although the skeleton is a well-known thyroid hormone target organ, very little data are available on the association of thyroid function with bone outcomes during childhood. OBJECTIVE To study the association of thyroid function with bone mass during childhood. DESIGN, SETTING, AND PARTICIPANTS Population-based prospective cohort including 4204 children with TSH and free T4 (FT4) measured at the age of 6 years. MAIN OUTCOME MEASURES Bone density was assessed by a total body dual-energy X-ray absorptiometry scan at the median age of 6 years (95% range, 5.6 to 7.9) and at the age of 10 years (95% range, 9.0 to 10.9) in 4204 and 3404 participants, respectively. RESULTS There was an inverse association of TSH with bone mineral density (BMD) at the age of 6 (β -0.028 ± 0.011, P = 0.009) and with follow-up measurements at the age of 10 (β -0.027 ± 0.011, P = 0.014), but not with bone mineral content (BMC) at the age of 6 (β -0.028 ± 0.015, P = 0.06) or for follow-up measurements of BMC at the age of 10 (β -0.011 ± 0.015, P = 0.47). There was an inverse association of FT4 with BMD (β -0.016 ± 0.006, P = 0.014) and BMC (β -0.023 ± 0.009, P = 0.009) cross-sectionally, and also at the age of 10 years (BMD: β -0.018 ± 0.007, P = 0.007; BMC: β -0.021 ± 0.009, P = 0.020). CONCLUSION A higher FT4 concentration is associated with lower bone mass at the age of 6 and at the age of 10 years. These data provide insights into the effects of thyroid function on bone physiology during childhood.
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Affiliation(s)
- Karlien Veldscholte
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Mirjana Barjaktarovic
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Katerina Trajanoska
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Vincent W V Jaddoe
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, GE Rotterdam, Netherlands
| | - Theo J Visser
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Yolanda B de Rijke
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Clinical Chemistry, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- Department of Epidemiology, Erasmus Medical Center, GE Rotterdam, Netherlands
| | - Tim I M Korevaar
- Department of Internal Medicine, Erasmus Medical Center, GE Rotterdam, Netherlands
- The Generation R. Study Group, Erasmus Medical Center and Sophia Children's Hospital, GE Rotterdam, Netherlands
- Academic Center for Thyroid Diseases, Erasmus Medical Center, GE Rotterdam, Netherlands
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8
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Ogawa E, Isojima T, Sato Y, Motoyama K, Kodama H. Sexual precocity in a girl with early-onset Graves’ disease. Clin Pediatr Endocrinol 2018; 27:165-169. [PMID: 30083033 PMCID: PMC6073066 DOI: 10.1297/cpe.27.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/25/2018] [Indexed: 11/09/2022] Open
Abstract
We describe the case of a girl diagnosed with Graves’ disease (GD) at 2 yr of age, who
developed early puberty. Preoperative examination for craniosynostosis revealed
thyrotoxicosis. While she was tall and her bone age was advanced at GD onset, her linear
growth attenuated after commencement of anti-thyroid treatment. However, at approximately
6 yr of age, breast budding was recognized. Hormonal analysis revealed pubertal levels of
LH response to a GnRH stimulation test and serum E2. Gonadal suppression therapy with GnRH
agonist was initiated, and her adult stature slightly exceeded the genetic potential.
Although accelerated growth and skeletal maturation are often reported to occur at GD
onset in prepubertal patients, early puberty is unusual, and this is the first reported
case of sexual precocity in a girl with GD.
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Affiliation(s)
- Eishin Ogawa
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Isojima
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Sato
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Kahoko Motoyama
- Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroko Kodama
- Department of Dietetics, Faculty of Health and Medical Science, Teikyo Heisei University, Tokyo, Japan
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9
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Neuropsychiatric manifestations of Graves disease in paediatric patients. NEUROLOGÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.nrleng.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Nilsson O, Isoherranen N, Guo MH, Lui JC, Jee YH, Guttmann-Bauman I, Acerini C, Lee W, Allikmets R, Yanovski JA, Dauber A, Baron J. Accelerated Skeletal Maturation in Disorders of Retinoic Acid Metabolism: A Case Report and Focused Review of the Literature. Horm Metab Res 2016; 48:737-744. [PMID: 27589347 PMCID: PMC5534175 DOI: 10.1055/s-0042-114038] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Nutritional excess of vitamin A, a precursor for retinoic acid (RA), causes premature epiphyseal fusion, craniosynostosis, and light-dependent retinopathy. Similarly, homozygous loss-of-function mutations in CYP26B1, one of the major RA-metabolizing enzymes, cause advanced bone age, premature epiphyseal fusion, and craniosynostosis. In this paper, a patient with markedly accelerated skeletal and dental development, retinal scarring, and autism-spectrum disease is presented and the role of retinoic acid in longitudinal bone growth and skeletal maturation is reviewed. Genetic studies were carried out using SNP array and exome sequencing. RA isomers were measured in the patient, family members, and in 18 age-matched healthy children using high-performance liquid chromatography coupled to tandem mass spectrometry. A genomic SNP array identified a novel 8.3 megabase microdeletion on chromosome 10q23.2-23.33. The 79 deleted genes included CYP26A1 and C1, both major RA-metabolizing enzymes. Exome sequencing did not detect any variants that were predicted to be deleterious in the remaining alleles of these genes or other known retinoic acid-metabolizing enzymes. The patient exhibited elevated plasma total RA (16.5 vs. 12.6±1.5 nM, mean±SD, subject vs. controls) and 13-cisRA (10.7 nM vs. 6.1±1.1). The findings support the hypothesis that elevated RA concentrations accelerate bone and dental maturation in humans. CYP26A1 and C1 haploinsufficiency may contribute to the elevated retinoic acid concentrations and clinical findings of the patient, although this phenotype has not been reported in other patients with similar deletions, suggesting that other unknown genetic or environmental factors may also contribute.
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Affiliation(s)
- Ola Nilsson
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
- Center for Molecular Medicine and Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Nina Isoherranen
- Department of Pharmaceutics School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Michael H. Guo
- Program in Biological and Biomedical Sciences, Harvard Medical School, Boston, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Julian C. Lui
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Youn Hee Jee
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ines Guttmann-Bauman
- Harold Schnitzer Diabetes Health Center, Oregon Health and Science University, Portland, OR, USA
| | - Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Winston Lee
- Department of Ophthalmology, Columbia University, New York, NY, USA
| | - Rando Allikmets
- Department of Ophthalmology, Columbia University, New York, NY, USA
- Department of Pathology and Cell Biology, Columbia University, New York, NY, USA
| | - Jack A. Yanovski
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Andrew Dauber
- Cincinnati Center for Growth Disorders, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey Baron
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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11
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Pimentel J, Chambers M, Shahid M, Chawla R, Kapadia C. Comorbidities of Thyroid Disease in Children. Adv Pediatr 2016; 63:211-26. [PMID: 27426902 DOI: 10.1016/j.yapd.2016.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Janiel Pimentel
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Melissa Chambers
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Madhia Shahid
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Reeti Chawla
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA
| | - Chirag Kapadia
- Phoenix Children's Hospital, 1919 E Thomas Road, Phoenix, AZ 85016, USA.
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12
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Losada-Del Pozo R, Soto-Insuga V, Martínez González M, Soriano Guillén L. Neuropsychiatric manifestations of Graves' disease in paediatric patients. Neurologia 2015; 32:196-197. [PMID: 26096670 DOI: 10.1016/j.nrl.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/06/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- R Losada-Del Pozo
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España.
| | - V Soto-Insuga
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - M Martínez González
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
| | - L Soriano Guillén
- Servicio de Pediatría, Hospital Universitario Fundación Jiménez Díaz, Madrid, España
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13
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Shakhsheer BA, Bordini B, Abdulrasool L, Grogan R, Kaplan E. Thyroidectomy in a two-year old for graves' disease. Int J Surg Case Rep 2015; 8C:131-3. [PMID: 25661638 PMCID: PMC4354700 DOI: 10.1016/j.ijscr.2015.01.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 11/28/2022] Open
Abstract
The most common cause of hyperthyroidism in children is graves’ disease. Surgery is utilized as a therapy for graves’ disease but rarely employed in children. This case report represents the youngest patient to undergo thyroidectomy for graves’ disease.
Introduction The most common cause of hyperthyroidism in children is graves’ disease – an autoimmune disorder in which antibodies stimulate the thyrotropin receptor to signal growth thyroid gland by increasing thyroid hormone synthesis and release. It can be treated with medical therapy, radioactive iodine, or surgery. Presentation of case JD was a two year old male who presented with severe diarrhea and diffuse neck enlargement. Laboratory work up was consistent with graves’ disease. Discussion Despite maximal outpatient and inpatient treatment with methimazole, atenolol, prednisone, and SSKI, he suffered persistent thyrotoxicosis. He underwent near-total thyroidectomy without complication. Conclusion This case is notable as it may represent the youngest patient in the literature who has undergone thyroidectomy for graves’ disease.
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Affiliation(s)
- Baddr A Shakhsheer
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, 5841 S Maryland Avenue, MC 6040, Chicago, IL 60637, USA.
| | - Brian Bordini
- Academic Endocrinology, 1315 Macom Drive, Suite 007, Naperville, IL 60564, USA
| | - Layth Abdulrasool
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, 5841 S Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Raymon Grogan
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, 5841 S Maryland Avenue, MC 6040, Chicago, IL 60637, USA
| | - Edwin Kaplan
- Department of Surgery, Endocrine Surgery Research Program, The University of Chicago, 5841 S Maryland Avenue, MC 6040, Chicago, IL 60637, USA
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Ho YH, Chung EC, Park SA. A 3-year-old girl with Graves' disease with literature review. Ann Pediatr Endocrinol Metab 2014; 19:154-8. [PMID: 25346920 PMCID: PMC4208264 DOI: 10.6065/apem.2014.19.3.154] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 09/10/2014] [Accepted: 09/19/2014] [Indexed: 11/20/2022] Open
Abstract
Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3) and free thyroxine (free T4) were normal, whereas that of thyroid-stimulating hormone (TSH) was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.
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Affiliation(s)
- Yo Han Ho
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Eun Cho Chung
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
| | - Sin-Ae Park
- Department of Pediatrics, Presbyterian Medical Center, Jeonju, Korea
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Sato H, Minamitani K, Minagawa M, Kazukawa I, Sugihara S, Wataki K, Konda S, Inomata H, Sanayama K, Kohno Y, Sasaki N. Clinical features at diagnosis and responses to antithyroid drugs in younger children with Graves' disease compared with adolescent patients. J Pediatr Endocrinol Metab 2014; 27:677-83. [PMID: 24756042 DOI: 10.1515/jpem-2013-0288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 02/28/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate clinical manifestations, laboratory findings, and effects of antithyroid drugs in younger children with Graves' disease (GD). DESIGN A retrospective and collaborative study. SETTING Nine facilities in Chiba prefecture, Japan. PATIENTS We analyzed 132 children and adolescents with GD. The subjects were divided according to the median age into a group of young children (group I, 4.1-12.4 years, n=66) and an adolescent group (group II, 12.5-15.9 years, n=66). MAIN OUTCOME MEASURES Clinical manifestations, laboratory findings, incidence of adverse effects, and remission rates 5 years after initial therapy were assessed. RESULTS The mean height SD score of group I (1.0) was higher than that of group II (0.3, p<0.001). The mean BMI SD score of group I (-0.7) was lower than that of group II (-0.3, p<0.05). The most common presentations were goiter, sweating, and hyperactivity in group I, whereas the most common presentations were goiter, sweating, and easy fatigability in group II. Hyperactivity was more frequent in group I (56.7%) than in group II (37.9%, p<0.05). Liver dysfunction appeared more often in group I (14.3%) than in group II (1.9%, p<0.05). There was no difference in the appearance of adverse effects between the two groups. The remission rate was slightly lower in group I (23.1%) than in group II (31.3%), but was not significant. CONCLUSIONS Thyrotoxicosis had more influence on the growth and liver function in younger children.
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Abstract
We report a child presenting with intermittent ophthalmoplegia and fluctuating ptosis and facial weakness whose evaluation revealed no evidence of myasthenia gravis but did reveal hyperthyroidism secondary to Graves disease. Successful treatment of the child's endocrinopathy resulted in complete resolution of his presenting symptoms. Children presenting with ophthalmoplegia and ptosis without proptosis should be evaluated for hyperthyroidism if no evidence of a myopathy or disorder of neuromuscular junction transmission is found.
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Affiliation(s)
- Seth J Perlman
- 1Department of Neurology, Washington University, St Louis, MO, USA
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Association between age at diagnosis of Graves' disease and variants in genes involved in immune response. PLoS One 2013; 8:e59349. [PMID: 23544060 PMCID: PMC3609789 DOI: 10.1371/journal.pone.0059349] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 02/13/2013] [Indexed: 11/19/2022] Open
Abstract
Background Graves' disease (GD) is a complex disease in which genetic predisposition is modified by environmental factors. The aim of the study was to examine the association between genetic variants in genes encoding proteins involved in immune response and the age at diagnosis of GD. Methods 735 GD patients and 1216 healthy controls from Poland were included into the study. Eight genetic variants in the HLA-DRB1, TNF, CTLA4, CD40, NFKb, PTPN22, IL4 and IL10 genes were genotyped. Patients were stratified by the age at diagnosis of GD and the association with genotype was analysed. Results Polymorphism in the HLA-DRB1, TNF and CTLA4 genes were associated with GD. The carriers of the HLA DRB1*03 allele were more frequent in patients with age at GD diagnosis ≤30 years than in patients with older age at GD diagnosis. Conclusions HLADRB1*03 allele is associated with young age at diagnosis of Graves' disease in polish population.
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Bauer AJ. Approach to the pediatric patient with Graves' disease: when is definitive therapy warranted? J Clin Endocrinol Metab 2011; 96:580-8. [PMID: 21378220 DOI: 10.1210/jc.2010-0898] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Pediatric Graves' disease accounts for 10-15% of thyroid disorders in patients less than 18 yr of age. The onset of symptoms may be insidious and subsequently associated with a delay in diagnosis. Decreased concentration and poor school performance are frequent complaints and can be quite frustrating for the patient and family. Severe ophthalmopathy is uncommon. The diagnosis is established by the findings of an increased heart rate and goiter in the setting of a suppressed TSH and elevated T(3) and/or T(4). The majority of pediatric patients are initially placed on antithyroid medications and maintained on these medications for prolonged periods of time in hopes of achieving remission. Unfortunately, for many children and adolescents remission is unattainable, ultimately occurring in only 15-30% of patients. Several recent studies have suggested that the age of the patient, the degree of thyrotoxicosis at diagnosis, the initial response to therapy, and the level of TSH receptor antibodies serve as reasonable predictors of remission and relapse. However, a consensus on the utility of these markers has not been reached. The present clinical case describes an adolescent with Graves' disease and highlights the negative impact that prolonged medical therapy can have on quality of life and school performance; it reviews pertinent data on the diagnosis, comorbidities, and treatment options; and it identifies gaps in knowledge for when definitive therapy should be pursued. The case serves as a reminder that earlier discussion and decision for definitive therapy should be more commonplace in caring for our pediatric patients with Graves' disease.
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Affiliation(s)
- Andrew J Bauer
- Department of Pediatrics, Walter Reed Army Medical Center, Washington, D.C. 20307, USA.
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Abstract
OBJECTIVE Thyroid hormones are involved in metabolic regulation, but the degree to which they affect body weight and body mass index (BMI) in children is unclear. We examined the effect of hypo- and hyperthyroidism on weight and BMI at the time of diagnosis and after appropriate treatment. DESIGN Prospective and retrospective case series. PATIENTS Children referred for thyroid dysfunction were enrolled prospectively if their total or free T4 was elevated with TSH <0·05 mIU/ml (N = 57) or if they had a subnormal total or free T4 and TSH >20 (N = 29). RESULTS Almost all patients had at least 2 classic signs or symptoms including goitre, but hyperthyroid patients had more symptoms. Mean BMI z scores at the time of diagnosis did not significantly differ between the two groups. Males with hyperthyroidism complained of weight loss more frequently and had a lower pretreatment BMI z score than hyperthyroid females. Hypothyroid patients lost a minimal amount of weight by the first follow-up (mean of 0·3 kg) and on average gained weight by the second follow-up visit. In contrast hyperthyroid patients gained a mean of 3·4 kg at the first follow-up visit and a mean of 7·1 kg by the second. CONCLUSIONS Correction of hypothyroidism resulted in minimal weight loss, suggesting that hypothyroidism does not cause significant weight gain in children. In contrast, correction of the hyperthyroid state had a somewhat greater impact on weight status. These results are consistent with prior reports but surprising given the opposite metabolic effects of hypo- and hyperthyroidism.
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Affiliation(s)
- Melissa K. Crocker
- Program on Developmental Endocrinology and Genetics, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) National Institutes of Health (NIH)
| | - Paul Kaplowitz
- Department of Endocrinology, Children's National Medical Center
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Ajala AM, Goodwin JA, Goodwin SR, Josephson GD. Undiagnosed Graves' Disease contributing to sleep disordered breathing in a child undergoing adenotonsillectomy. Paediatr Anaesth 2008; 18:358-9. [PMID: 18315665 DOI: 10.1111/j.1460-9592.2008.02482.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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