Abstract
Previous studies have identified frequent comorbid neuropsychiatric disorders and conditions in adults with thyrotoxicosis. These studies are scarce or even lacking in pediatric population. This work aimed to study the behavior of children and adolescents with Graves' disease (GD). This study included 35 children with GD (boys = 15; girls = 25; mean age: 11.45±1.50yrs) and 40 healthy children (boys = 20; girls = 20; mean age: 12.54±1.62yrs). Behavior was assessed using Child Behavior Checklist (CBCL). Children with GD were assessed during periods of thyroid hormone elevation (active disease) and normalized thyroid hormones (with anti-thyroid drugs or ATDs). Compared to healthy children, patients during periods of thyroid hormone elevation (74.29%) and normalized thyroid hormones (31.43%) had higher frequencies of behavioral abnormalities and scorings of total CBCL scale (P = 0.01; P = 0.04, respectively) and its subscales' [Anxious/Depressed (P = 0.02; P = 0.04), Withdrawn/Depressed (P = 0.03; P = 0.04) and Somatic Complaints (P = 0.03; P = 0.127) and Social (P = 0.01; P = 0.225), Thought (P = 0.01; P = 0.128) and Attention (P = 0.01; P = 0.01) problems], indicating internalizing and externalizing problems. The majority of patients had at least two different behavioral problems. Marked improvement was found during period of normalized thyroid hormones (P = 0.001). Correlation analyses showed significant associations between total CBCL scoring and age at onset (P = 0.01; P = 0.001) and lower concentrations of thyroid stimulating hormone (TSH) (P = 0.001; P = 0.04) and higher concentrations of free thyroxine (fT4) (P = 0.01; P = 0.02), triiodothyronine (fT3) (P = 0.01; P = 0.03) and thyrotropin receptor antibodies (TRAbs) (P = 0.001; P = 0.01) during periods of thyroid hormone elevation and normalized thyroid hormones, respectively. Multiple linear regression analysis showed that "at presentation" lower concentrations of TSH (P = 0.001; P = 0.03) and higher concentrations of fT4 (P = 0.001, P = 0.01), fT3 (P = 0.01; P = 0.06) and TRAbs (P = 0.001; P = 0.001) were predictors of behavioral problems during periods of active disease and normalized thyroid hormones. We conclude that GD is associated with higher frequencies and severities of anxiety, depression and inattention during periods of thyroid hormone elevation as well as normalized thyroid hormones with ATDs. Therefore, early diagnosis and optimizing management are required to improve children's social life.
Highlights
Graves’ disease (GD) is the most common cause of childhood hyperthyroidism
The diagnostic criteria for GD included the presence of clinical hyperthyroidism and reduced thyroid-stimulating hormone (TSH), and elevated free thyroxine and triiodothyronine blood concentrations, and high titers of thyrotropin receptor antibodies (TRAbs) [10]
There were no differences between children ’with drug-corrected state and healthy children in thyroid laboratory markers (TSH, fT3, fT4 and TRAbs) (Table 1)
Summary
Graves’ disease (GD) is the most common cause of childhood hyperthyroidism. It accounts for 10–15% of thyroid diseases in children less than 18 years old [1]. Psychiatric assessment of adults with different states of hyperthyroidism [subclinical, overt or normal thyroid hormone levels’ state with anti-thyroid drugs (ATDs) or thyroidectomy], is the focus of some studies and reviews These studies documented the occurrence of more severe somatic manifestations beyond the integral manifestations of thyrotoxicosis and other comorbid neuropsychiatric conditions and disorders [4,5,6]. The frequently reported neurobehavioral manifestations in children with thyrotoxicosis include cognitive deterioration or poor scholastic achievement, hyperactivity, irritability or anxious dysphoria, and problems of attention [8, 9] It is not clear whether the neuropsychiatric complications of thyrotoxicosis (whether in children or adults) follow a course parallel to the resolution of thyrotoxicosis or remain the same even after achievement of normal thyroid hormone levels with ATDs or thyroidectomy
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