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:stars:Graves' disease :fire_engine: (Thy4) (:champagne:Introduction…
:stars:Graves' disease :fire_engine: (Thy4)
:champagne:
Introduction
Autoimmune disorder
Thyrotropin (TSH) receptor stimulation by autoAbs
Incidence: 0.02% of children
Peak in adolescent
:green_salad:
Clinical
clinical dx
Hyperthyroid symptoms
:grapes:
Goiter
Ophthalmopathy
:male-scientist::skin-tone-3:
Investigations
TFTs:
supressed TSH
:arrow_up: FT3
:arrow_up: FT4
TRAb (anti-thyrotropin receptor ab -
gold standard
)
AntiTPO, AntiTg -- not เด่น in Graves'
Imaging:
Thyroid ultrasonography
Thyroid scan
:green_heart:
Treatment
:sunflower:
Pharmacologic
therapy
Antithyroid
drugs: PTU, MMI
:evergreen_tree:
initial Rx in children
Doses
Propylthiouracil (PTU or 6-propyl-2-thiouracil): 5-10 MKDay
Methimazole (MMI) prefer in
children
: 0.5-1 MKDay
Mechanism
Interfere with TPO-mediated iodination of tyrosine residues
Block conversion from T4 to T3 (
PTU
)
Immunosuppressive effects
SEs
Major
stop drugs!
Agranulocytosis
Polyarthritis
ANCA-positive vasculitis
Immunologic hepatitis
Minor
can continue drugs
Skin reaction
Arthralgia
GI side effects
Sialadenitis
Prognosis
Treatment at least 2 - 3 yr
Children: remission < 30%
Relapse: usu 3-6 mo after stopped therapy
Overall relapse 50-60%
Beta-blockers: propanolol (1-2 MKDay)
:sunflower:
Radioactive iodine therapy
Goal: induced hypothyroidism
:no_entry:
C/I
: Pregnancy, Lactation
:warning:
Be careful
should be avoided in very young children (< 10 yrs)
Contraception 6-12 months after RAIU
Complication: Thyroiditis
:sunflower:
Surgery
Prefer :one:.
total thyroidectomy
in
children
:two: Near total thyroidectomy
Selected cases
Major complicatioins fr Anti-thyroid drugs
Pregnant women need high doses of anti-thyroid drug
Large goiters or suspicious nodules
Complications
Permanent hypoparathyroidism
Recurrent laryngeal nerve damage