Paediatric Hyperthyroidism - UK Survey of Clinicians

Objective: We
aimed to document current practice in the medical management of paediatric hyperthyroidism
in the UK and compare to international recommendations.

Design: A 27
question online survey was distributed via an electronic newsletter in August
2018.

Participants:
Members of the British Society for Paediatric Endocrinology and Diabetes.

Measurements: We
collected information about anti-thyroid drug (ATD) preference, treatment
duration, criteria used to monitor full blood count (FBC), management of
neutropaenia, agranulocytosis screening and patient education.

Results:
Carbimazole is favoured by 98% of respondents and a ‘dose titration’ regimen
preferred over ‘block and replace’ (65% versus 29%). TRAbs (Thyroid Receptor
Antibodies) are used for diagnostic purposes by 85% and by 33% to look for
evidence of disease remission. The majority (81%) treat for a minimum of 2
years before considering a trial off ATD. All respondents reported that they
‘always/usually’ warn their patients about the risk of agranulocytosis before
starting ATD, but written information is ‘rarely/never’ provided by 63%. Sore
throat (98%) and fever (92%) are the most commonly cited symptoms used to alert
a patient to possible agranulocytosis. FBC is measured prior to treatment by
65% and measured periodically during treatment by 70%.

Conclusions: The
management of paediatric hyperthyroidism with ATDs in the UK is not consistent with all international
recommendations because a block and replace ATD regimen remains widely used.
TRAbs are utilised at presentation, but under-used for detecting disease
remission. National consensus guidelines and written patient information may
refine the management of paediatric patients on ATDs.