Thyroid Disorders in Childhood and Adolescence: Analysis of Clinical Data and Management Challenges in Patients Seen in a Nigerian Teaching Hospital

Background: In Nigeria, and perhaps other African countries, thyroid disorders in childhood and adolescence have not been sufficiently studied. Where studies are available, they were either conducted decades ago or they involved only adults. Objective: To describe the pattern of thyroid disorders among children and adolescents seen in a Nigerian teaching hospital and highlight the management challenges encountered. Methods: In this retrospective study, the case notes of all the children and adolescents with thyroid disorders seen in the Paediatric Endocrine-Metabolic Clinic and of those admitted into the wards of the University of Benin Teaching Hospital (UBTH) were audited. Information extracted included age, gender, duration of symptoms before presentation, clinical features, laboratory test results, management challenges and admission outcome. The total number of new cases seen at the paediatric clinics of the Department of Child Health, UBTH was derived from the clinic attendance register of the department. Results: Of the 8,350 new cases seen during the 7-year period, 9(0.12%) had thyroid disorders, representing one per 1000 new cases. Of the 9 patients with thyroid disorders, 6 (66.7%) had hyperthyroidism, 2(22.2%) had nongoitrous hypothyroidism and 1(11.1%) had euthyroid goiter. The overall mean age at presentation for thyroid disorders was 11.2+4.3 years (95% Confidence Interval, CI = 8.4-14.0)and female-to-male ratio was 4:1. For the patients with hyperthyroidism, the mean age of presentation was 12.8+3.1 years (95% CI= 10.3-15.3) and female-to-male ratio was 5:1. The mean age at presentation of the two children (a boy and a girl) with hypothyroidism was 4.75 years (range 3.5 and 6 years). The mean duration of symptoms before presentation was as follows: thyroid disorders 1.72+1.2 years (95% CI=0.94-2.50), hyperthyroidism 8.5+1.5 months (95% CI=7.3-9.7). The only case of euthyroid goiter (female) presented at the age of 14 years. The management challenges encountered included suboptimal diagnostic facilities and high clinic default rate. Conclusion: Hyperthyroidism was the most common form of thyroid disorder observed and patients with thyroid disorders tended to present late. Suboptimal diagnostic facility and high clinic default rate were the principal management challenges encountered.