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.<b></b><br>