Treatment of hyperthyroidism in children and adolescents

The therapy of thyrotoxicosis in children and adolescents requires careful selection of a primary mode of therapy and secondary therapy if the hypermetabolic manifestations compromise the patient's function at home or in school. The three principle modes of primary therapy, thioamide blockade, subtotal thyroidectomy and radioiodine, are critically reviewed as to advantages, disadvantages, and results. Secondary symptomatic therapy is discussed with an emphasis on the usefulness of beta adrenergic blockade. The application of each potential mode of therapy is discussed. The etiology, natural history, and therapy of neonatal thyrotoxicosis is reviewed. The author concludes that for the majority of patients in this age group with toxic diffuse goiter, definitive thioamide therapy carries the least potential for major complications. An effective approach for utilizing methimazole is outlined.