Clinical Analysis Of Autoimmune Thyroid Disease In Children

Objectives:To improve the understanding of the clinical features of Graves'disease?GD?in children and the therapeutic effect of Antithyroid drugs?ATD?,as well as the natural course and prognosis of Hashimoto's thyroiditis?HT?in children.To pay more attention to the early identification of thyroid crisis in children.Methods:This paper retrospectively analyzes 66 children and adolescents under 18 years old diagnosed as Graves'disease and 76 children and adolescents diagnosed as Hashimoto's thyroiditis,who have received treatment in the outpatient section of the pediatrics department of the First Hospital of Qinhuangdao?FHQ?from 2011 to 2018.This paper also reports a clinical case of a child with thyroid crisis admitted to the pediatrics department of the First Hospital of Qinhuangdao.Results:1.The male-female ratio of 66 GD patients in this study was 1:4.5,Thyroid enlargement,hyperhidrosis and exophthalmos were the most common clinical manifestations.Among these 66 patients,there were 2 children complicated by type 1 diabetes mellitus,1 by vitiligo and 1 by thyroid crisis.By the time of follow-up,after 6 months to 9 years and 11 months course of treatment,only 1 patient was cured,1 relapsed after withdrawal of medications,1 had just stopped medications,1 received replacement therapy with levothyroxine sodium after hypothyroidism caused by I¹³¹ therapy,and the rest were in continuous treatment.Adverse reactions occurred in 12 children,including 6cases of transient neutropenia,2 cases of rash,1 case of agranulocytosis and 3cases of liver function damage.2.The male-female ratio of 76 HT patients in this study was 1:4.4.Neck enlargement was the main reason for seeking medical treatment,the thyroid function state of HT patients at first diagnosis could be manifested as normal thyroid function,subclinical hypothyroidism,hypothyroidism and Hashimoto's hyperthyroidism.The thyroid function of the patients will change greatly with time.3.Children with thyroid crisis were discharged from hospital after comprehensive treatment such as anti-infection,antithyroid drugs,steroid hormones,?-adrenoceptor blockers,antipyretic drugs,granulocyte colony stimulating factor,together with I¹³¹ treatment.Conclusion:1.The treatment of GD in children is basically the same as in adults.At present,antithyroid drugs are the main treatment for hyperthyroidism in China.For children with hyperthyroidism,especially those who are younger in onset,drug therapy should last at least until puberty or even after puberty.Although scholars at home and abroad still recommend ATD treatment as the first-line treatment for Graves'disease in children,if the condition is serious,thyroid function recovers slowly and fluctuates greatly in the initial treatment stage,or drug dosage is large in the maintenance stage and the compliance of the child is poor,I¹³¹ treatment may be considered after parental consent.2.All HT patients should regularly monitor thyroid function in order to find and treat obvious hypothyroidism as early as possible.3.When the child has high fever,significant tachycardia and multiple organ injury,such as central nervous system,cardiovascular system and gastrointestinal symptoms,the possibility of thyroid crisis should be considered.Children with confirmed and suspected thyroid crisis should receive comprehensive treatment in intensive care unit?ICU?.