Autoimmune hyperthyroidism in children & adolescents in Sudan: a 13 years’ experience of a Paediatric Endocrinology Clinic

Ghassan Faisal Fadlalbarihttp://orcid.org/https://orcid.org/0000-0003-0823-1682 1 , Renson O. Mukhwana 2 ,  and Mohamed Ahmed Abdullah 3
  • 1 Paediatric Endocrinology and Diabetes Unit, Gafar Ibn Auf Specialized Children Hospital, Khartoum, Sudan
  • 2 Department of Paediatric Endocrinology and Diabetes, Gertrude Garden Children Hospital, Nairobi, Kenya
  • 3 Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Sudan and Endocrinology Unit, Gafar Ibn Auf Specialized Children Hospital, Khartoum, Sudan
Ghassan Faisal FadlalbariORCID iD: https://orcid.org/0000-0003-0823-1682, Renson O. Mukhwana
  • Department of Paediatric Endocrinology and Diabetes, Gertrude Garden Children Hospital, Nairobi, Kenya
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and Mohamed Ahmed Abdullah
  • Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Sudan and Endocrinology Unit, Gafar Ibn Auf Specialized Children Hospital, Khartoum, Sudan
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Abstract

Background

Little has been published about hyperthyroidism in children from Sudan or Africa. In limited resource countries, lack of facilities and sociocultural factors might make international diagnosis and management guidelines difficult to follow. We aimed to determine the magnitude of autoimmune hyperthyroidism, clinical presentation, diagnosis, management and its outcome in Sudan.

Method

Records of all patients diagnosed as Graves’ disease (GD) or Hashitoxicosis (HTx) were reviewed and missing data filled by interviewing patients and/or their families. Data including age, sex, clinical presentation, investigations, management and outcome were obtained.

Results

Eighty-eight patients, 80 with GD (F:M = 4.7:1) and 8 with HTx (F:M = 7:1), were diagnosed at 11.8 ± 3.05 and 11.23 ± 2.78 years, respectively (p = 0.52). GD patients were diagnosed based on presence of exophthalmos (66.25%), positive thyroid receptor autoantibodies (12.5%), prolonged illness duration (8.75%) or remission failure to only B blocker (16.25%). All GD patients were started on carbimazole and cumulative remission rate was 11.8%, 32.4% and 41.2% by end of the second, third and fourth year respectively, however it plateaus after that. While 12 GD patients underwent surgery, only three opted for radioiodine ablation.

Conclusion

Hyperthyroidism is not an uncommon problem. In absence of laboratory facilities, differentiation between GD and HTx can be made based on clinical grounds. Continuation of medical treatment for 4 years can increase the remission rate to 41.2%. In Sudan, surgery is the preferred method of definitive therapy.

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The Journal of Pediatric Endocrinology and Metabolism (JPEM) is the only international journal dedicated exclusively to endocrinology in the neonatal, pediatric and adolescent age groups, and publishes the results of clinical investigations in pediatric endocrinology and basic research. JPEM publishes Review Articles, Original Research, Case Reports, Short Communications and Letters to the Editor.

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