Enfermedad de Graves-Basedow en la infancia y la adolescencia: aspectos clinicobiológicos en 49 casos

Pavía Sesma, C.; Villanueva Lamas, J.; Torres Lacruz, M.; Valls Tolosa, C.; Rodríguez Hierro, F.

doi:10.1016/S1695-4033(00)77405-4

Información del artículo

Estadísticas

Fundamento

La enfermedad de Graves-Basedow es rara en la infancia y la adolescencia.

Pacientes y método

Se han evaluado 6 niños y 43 niñas, con edades comprendidas entre 2 y 18 años. Todos presentaban un bocio difuso y sintomatología de hipertiroidismo. Las concentraciones de T4, FT4, T3 y TSH se determinaron por radioinmunoanálisis con diferente sensibilidad a lo largo del tiempo y los anticuerpos, por hemaglutinación. Todos fueron tratados con fármacos antitiroideos.

Resultados

En 5 casos se detectó un aumento de la velocidad de crecimiento y en otros 5 había una asociación con otras autoinmunopatías. El índice de Quetelet estaba entre los percentiles 90 y 97 en 5 casos, y entre 3 y 10 en 8 casos. Los resultados bioquímicos fueron: T4 282,41 ± 1,1 nmol/l; FT4 62,98 ± 1,1 pmol/l; T3 4,92 ± 0,07 nmol/l; TSH 0,002 mU/l. Los valores de TSI/TRAb fueron 33,23 ± 1,95 U/l. Sehan obtenido 4 remisiones totales y una parcial. En 4 ocasionesse recurrió a cirugía y 8 pacientes recibieron 131I.

Conclusiones

Se han obtenido pocas remisiones con el tratamiento médico y el radioyodo parece ser una terapéutica alternativa.

Palabras clave:

Hipertiroidismo

Graves-Basedow

Radioyodo

Background and objective

Graves' disease is rare in childhood and adolescence.

Patients and method

Six boys and 43 girls between the ages of 2 and 18 years were evaluated. All presented diffuse goiter and symptomatology of hyperthyroidism. Concentrations of T4, FT4, T3 and TSH were determined by RIA with various sensitivities during the study. Thyroid antibodies were determined by hemagglutination. All patients were treated with antithyroid drugs.

Results

In five patients, growth velocity increased. In a further five patients association with other autoimmune diseases was detected. Quetelet's index was between the 90th and 97th percentiles in five patients and between 3th and 10th in eight. Biochemical results were as follows: T4: 282.41 ± 1.1 nmol/1; FT4: 62.98 ± 1.1 pmol/l; T3: 4.92 ±0.07 nmol/l) and TSH: > 0.002-0.001 mU/l. Values of TSI/TRAb were 33.23 ± 1.95 U/l. Four total remissions and 1 partial remission were observed. Four patients underwent surgery and eight received radioiodine.

Conclusions

Few remissions were obtained with medical treatment.Radioiodine seems to be a therapeutic alternative.

Key words:

Hyperthyroidism

Graves' disease

Radioiodine

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