Evaluation of children with goiter and treatment outcomes

Abstract

Aim: Goiter is defined as the enlargement of thyroid gland independent of the etiology. It is common in childhood, especially in adolescence. The prevalence of goiter in children aged 6 to 12 years of age was found as 24.9 to 92% in different studies performed in different regions of Turkey. The most common cause in endemic regions is iodine deficiency and it is chronic lymphocytic thyroiditis in non-endemic areas. The aim of this study was to evaluate the demographic and diagnostic characteristics; and physical, laboratory and radiological findings of the children who were presented and followed-up with goiter, and the efficacy of the treatments applied was also assessed.Materials and Methods: A total of 116 children diagnosed as having goiter by physical and ultrasonographic examination in the outpatient clinic of Pediatric Endocrinology Division of Uludag University Faculty of Medicine, between January 2000 and December 2005. Data of the patient were collected retrospectively from the files/records of the patients. Goiter grades of the patients were determined according to that recommended by WHO. Thyroid volumes were calculated from the ultrasonographic measurement of thyroid dimensions. Patients with euthyroid or hypothyroid goiter had L-thyroxine therapy and those with hyperthyroidism had propiltiourasil and/or propranolol.Results: Of all children, 80 (69%) were girls and the remaining 36 were boys (31%). At the time of initial diagnosis, the mean ages of the girls and the boys were 10.1 +/- 2.9 years and 9.02 +/- years, respectively. The mean follow-up period was 3.18 +/- 1.83 years. Most children (76.7%) had grade Ib (38.8%) or II (37.9%) goiter at the time of diagnosis. Of all children with goiter, 62 (53.4%) were euthyroid, 47 (40.5%) were hypothyroid and 7 (6.0%) were hyperthyroid. Seventy nine (68.1%) patients had history of thyroid disease in their families. There were additional endocrinological disturbances, epilepsy and other systemic diseases in 11 (9.5%), 11 (9.5%) and 7 (6.0%) patients, respectively. Eighty three (71.6%) patients had simple diffuse goiter, 18 had Hashimoto thyroiditis (4 of whom also having nodules), 11 (10.4%) had isolated noduler/multinodler goiter, 3 (2.6%) had Graves disease and 1 (0.9%) had papillary thyroid carcinoma. Mean thyroid volume by ultrasonography was significantly decreased from 12.68 +/- 3.57 (3.4 to 35.7) ml to 9.2 +/- 3.57 (3.19 to 22.1) ml with the treatment (p<0.05). Similarly goiter grades by physical examination were also significantly decreased, with only 36.2% of the patients having grade Ib (26.7%) or grade II (9.5%) goiter after the treatment (vs. a total of 76.7% at baseline) (p<0.01). Thyroid nodules were significantly regressed in 11 of 16 patients with noduler goiter (p<0.01).Conclusion: Since TSH (Thyroid-stimulating hormone) elevation seems to be the main driving force in the pathogenesis of thyroid enlargement, thyroxine treatment is warranted to suppress the TSH in hypothyroid and euthyroid patients. The number of hyperthyroid patients in our study is not sufficient to draw conclusions, and the pathogenesis of goiter in hyperthyroidism does not involve TSH which is already suppressed by endogenous thyroid hormones. Nevertheless, control of hyperthyroidism with antithyroid medication and appropriate introduction of thyroxine seem to remedy the goiter as well.