Disorders of thyroid gland in India

The profile of thyroid disorders encountered in pediatric and adolescent age groups in India is similar to that seen in most parts of the world except for the prevalence of iodine deficiency disorders in certain endemic regions of this country. Clinical presentation is most commonly for hypothyroidism and goiters and infrequently for hyperthyroidism. Of nearly 800 children referred for thyroid problems, 79% had hypothyroidism (goitrous as well as nongoitrous), 19% had euthyroid goiters and 2% had hyperthyroidism. Hypothyroidism was due to thyroid dysgenesis in 75% (aplasia/hypoplasia−50% and ectopic thyroid gland 25%), thyroiditis in nearly 5% and dyshormonogenes is in 20%. The incidence of congenital hypothyroidism in our experience of screening nearly 40,000 newborns is about 1 in 2,640, which is much higher than the worldwide average of 1 in 3,800. Diagnostic delay in hypothyroidism is common and is related to lack of awareness amongst primary healthy care practitioners and family physicians as well as the cost and availability of laboratory investigations. This delay, compounded with inadequate therapeutic surveillance is responsible for the poor outcome in affected children. High incidence of dyshormonogenesis, inherited as autosomal recessive trait also calls for genetic counselling and routine sibling examination. Our results of family studies on first degree relatives of children with thyroiditis revealed presence of antimicrosomal antibodies in 43% and thyroid disease in 26%. Many etiologic factors cause goiters which may be functionally euthyroid or hypothyroid with almost equal frequency in our series. In nearly 200 schools children surveyed for goiter prevalence, 8% in high socioeconomic groups and about 21% in the low income group, had goiters. Female predominance was marked. However, iodine deficiency was not the sole cause as revealed by dietary survey and urinary iodine estimations. Hyperthyroidism is infrequent, less severe and in our experience responded well to long-term administration of antithyroid drugs. A high index of clinical awareness and education of primary health workers will help a great deal in improving the ultimate outcome in children with thyroid disorders/hypothyroidism.     

Mixed papillary follicular carcinoma of the thyroid gland in childhood. Report of a case

The authors have reported a case of childhood Thyroid Carcinoma at a Pediatric Service. This report has been justified since this is an uncommon pathology in children and a very unusual clinical picture for children. The etiology and diagnostic have been reviewed by the authors. The clinical investigation as well as the clinical course of the disease has been present. The literature for thyroid cancer in children has also been reviewed. The need for a careful investigation in children with unusual radiologic finding has been emphasized; being the thyroid carcinoma metastasis diagnosis one of the possibilities.     

A follow-up study of childhood psychosis

A cohort of 227 children having attended the same day treatment facility during their childhood was followed-up in adult life. A questionnaire was designed to collect data on various aspects of social and personal adjustment. The length of the follow-up period is 17 years. Information was obtained on 99 subjects whose mean age was 27-years. Of these, 55 had been admitted to the facility for childhood psychosis, and the remaining 44 subjects served as a comparison group. The results show that, in adulthood, the psychotic children fare significantly worse than the controls for employment, autonomy, marriage and the need for continuing medical care. Although non significant, a trend is found in the same direction for educational attainment and medication consumption. We then looked at the clinical and therapeutic variables in the childhood of the psychotic group which were the strongest predictors of adjustment in adulthood. We found that those children who had been admitted at a younger age, whose length of stay in the day treatment hospital had been longer, who scored lower on IQ tests and who had been discharged towards other specialised institutions, were less well adjusted. The results of this study must be interpreted with caution in light of the important attrition during the follow-up period. The discussion then focuses on case definition issues. Emphasis is placed on the need for careful diagnostic assessment and for the use of precise diagnostic assessment and for the use of precise diagnostic criteria. Further, our result on the prognostic significance of IQ level suggests that the assessment of cognitive functioning in autistic and psychotic children is key information which should be more systematically taken into account both in clinical practice and in future research projects.     

Management of childhood and adolescent thyroid carcinoma: long-term follow-up and clinical characteristics.

AIM: This analysis was performed to evaluate clinical factors such as local tumor control, control of distant metastasis, survival, and complications in children and adolescents with thyroid carcinoma. MATERIALS AND METHODS: From 1960 to 2003, 21 children and adolescents (16 girls and 5 boys, aged 4 to 15 years) were treated for thyroid carcinoma in our departments. Clinical data, operative findings, pathological findings, operative procedures, intra- and postoperative complications and follow-up were evaluated. Follow-up of patients ranged from 3 to 42 years (median, 20 years). RESULTS: Papillary carcinoma was found in 20 patients (95%) and follicular carcinoma in one patient. Cervical lymph node metastases were found in 12 out of 21 patients (57.1%) when thyroid carcinoma was diagnosed, and 5 patients (23.8%) had pulmonary metastasis. In patients with pulmonary metastasis, total thyroidectomy and bilateral radical lymph node resection was performed in 3 patients, lobectomy of the thyroid and radical lymph node resection in one patient, and partial thyroidectomy in one patient. All three patients who underwent total thyroidectomy are still alive. Internal irradiation by 131I and thyroid hormone replacement therapy was administered to 2 of 3 patients with pulmonary metastasis. CONCLUSION: Despite metastasis in the lymph nodes and even the lungs, the prognosis for patients with papillary carcinoma is good. Total thyroidectomy and positive 131I therapy are recommended for childhood and adolescent thyroid carcinoma with pulmonary metastasis.     

Ectopic thyroid gland. A clinical study of 30 children and review.

Of 108 children being treated at our Institute for primary (nongoitrous) hypothyroidism, tests with radioactive iodine 131I uptake showed that 26 of them (24%) had an ectopic thyroid gland. Four euthyroid children also had anterior swellings of the neck which, in each case, proved to be an ectopic thyroid gland. Of the 30 children studied, 20 were girls and 10 were boys. Nine patients were diagnosed within the first year of life. Growth retardation, manifest in 20 patients, was the most common clinical finding at the time of diagnosis. Delayed bone age was a feature in all of them. Growth, after diagnosis was within normal limits in 83% of the infants who were treated within the first two years of life; only 50% of the children diagnosed later grew within normal limits. Similarly, mental function was best preserved in those patients in whom treatment was initiated within the first two years of life.     

Severe infections in childhood leukemia. A follow-up study of 100 consecutive ALL patients

Severe infections during the course of childhood ALL were surveyed as a whole in 100 consecutive patients, followed up for 2-8.5 years from the ALL diagnosis. The most important findings were a total absence of disseminated candidiasis, a relative infrequency of gram-negative septicemia (8 episodes), and a predominance of gram-positive cocci (29 episodes) in the 48 verified septicemias. S. aureus was responsible for 50% of culture-positive septicemias. The gram-positive predominance depended probably on local factors, and reservation in using broad-spectrum antibiotics might have played a part. There were 9 cases of disseminated Varicella-zoster, cured successfully with antiviral agents. Pneumocystis carinii pneumonitis numbered 8 episodes, concentrated to the early remission period. One case of miliary tuberculosis was found. Risk factors regarding age of patient and phase or intensity of cytotoxic therapy are evaluated.     

Fibrosing alveolitis in childhood. A long-term follow-up

A retrospective analysis of 14 pediatric cases with fibrosing alveolitis, proved by lung biopsy, was carried out. The children were initially 6-16 years old (mean: 9.8 years) and were observed for 2 to 7 years. Symptoms had been present prior to diagnosis for 1 to 156 weeks (median: 11 weeks). The most prominent clinical findings were dyspnoea (100%), dry cough (91%), tachypnoea (85%), and weight loss (70%). Open (n = 9) or transbronchial (n = 5) lung biopsy specimens had predominantly cellular appearances in 8 children (group A) and showed predominantly fibrotic changes in 6 cases (group B). Lung function tests revealed a marked ventilatory impairment in all children. Mean vital capacity was 44% (SD 16%), and total lung capacity 58% (SD 14%) of the predicted normal values. Specific lung compliance was significantly lower in children with fibrotic changes (mean: 0.016 vs. 0.030 ml/cmH2O/ml in patients of group A, p less than 0.05). Results from 200 lung function measurements were evaluated during the follow-up. Corticosteroid treatment improved vital capacity in all children after 6 and 12 months of treatment to 64% and 62% of the predicted normal, respectively. Deterioration of pulmonary function was observed in 7 children when prednisone was tapered to below 10 mg per day. Only 4 children had a normal vital capacity at their last visit to the clinic. We conclude that children with fibrosing alveolitis experience severe alterations in lung function, and that the overall outlook is quite unfavorable.