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La Franchi, Oregon, OR, USA, discussed treatment of congenital
hypothyroidism. The starting dose for neonates was advised to vary between
10 and 15 µg/kg/day. This dose should be decreased to 6-10 µg/kg/day
starting after one year. It was stressed that substitution doses should
be individualized.
Zimmermann, Rochester, MN, USA, discussed juvenile Graves' disease. More boys than girls suffer from Graves' disease and the clinical course is usually milder than in adults. ATD treatment results in 10% relapse after 5 years and 20% relapse after 10 years. Granulocytopenia occurs in 4.5% and agranulocytosis in 0.4% of patients. Skin rashes are seen in 9% of cases. Surgery results in recurrence rate of 3%, vocal cord paralysis of 1%, hypoparathyroidism of 2%, keloid formation of 2.8%, and hypothyroidism of 32% of cases. Mortality is rare. RAI treatment is effective in 98% of cases, relapse rate is about 1%. There is no indication that RAI treatment in children induces carcinoma or induces congenital abnormalities in their later offspring. The speaker suggests that ATD treatment should be employed when there is no or only a small goiter and a mild clinical course. Surgery is advised in large goiters and severe clinical symptoms, whereas he advised RAI treatment in case of recurrence after ATD or surgery. It was advised not to administer RAI below the age of 10 years. (Comment: Although the tendency to treat also children with RAI is increasing, there is still some hesitation. Often children are still operated and to our opinion this is a much more risky procedure than treatment with RAI, even at young ages.) Foley, Pittsburg, PA, USA, mentioned that after the nuclear fall-out (100 x 106 mCi 131I) in Chernobyl, at this moment 5% of children, that were exposed to the highest irradiation, appear to have thyroid carcinoma, and 4% of these children have distant metastases. It is expected that the incidence rate of juvenile carcinoma (mostly papillary carcinoma) will rise in the coming years. |
