Thyrotoxicosis in Children: a Follow-up Study.

or hypothyroidism. (b) Medical therapy: frequent and prolonged, with the need for supervision, the risk of toxic reactions, and the chance of eventual failure. Surgical mortality may be small but is present in most of the recQrded series (Hayles, Kennedy, Beahrs, and Woolner/ 1959; Kunstadter and Stein, 1955; McClintock, Frawley, and Holden, 1956; Van Wyk, Grumbach, Shepard, and Wilkins, 1956) where a total of 7 children died after 275 operations. Arnold et al. (1958) and Root, Bongiovanni, Harvie, and Eberlein (1963) had no mortality in 28 patients. In all these series the recurrence rate was not less than 5%, while no less than 73 children operated on were subsequently found to be hypothyroid. On the other hand some patients were submitted to operation only because medical therapy had failed. Medical therapy carries few risks. There are few reports of toxic drug reactions in children who seem to be at less risk than adults. Kunstadter and Stein (1955) had no reactions in 17 children treated with thiourea derivatives; Hung, Wilkins, and Blizzard (1962) reported maculo-papular rashes and fever in 2 of 9 children treated with perchlorate, urticarial rashes in 3 of 23 children who had propylthiouracil, and 'granulocytopenia accompanied by buccal ulceration and sore throat' in 1 of these children; Root et al. (1963) noted that 3 of their 17 children had mild leucopenia with fever and a skin rash. With these 9 and one child in the present series who developed leucopenia while on a small dose of methylthiouracil, there were, therefore, 10 children