Factors Influencing the Early Remission of Pediatric Thyrotoxicosis Within Two Years of Propylthiouracil Medication
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Abstract
Background : Propylthiouracil (PTU) is the anti-thyroid medication commonly used as a firstline therapy for pediatric thyrotoxicosis in Thailand. Because of low remission rate and long periods of medical therapy, several studies were attempted to identify factors associated with remission outcomes. These predicting factors remain controversial.
Objective : To evaluate predicting factors of early remission in pediatric thyrotoxicosis treated with PTU in Lampang Hospital.
Material and method : A cross-sectional analytical study was conducted on the patients age under 16 years who were diagnosed with thyrotoxicosis and treated with PTU at outpatient department of Lampang Hospital between 1st January 2002 and 28th February 2010. The general data, clinical findings, laboratory and treatment outcomes were retrospectively reviewed. The data was analyzed by descriptive statistics. Comparison between patients who achieved early remission within 2 years and who were treated for more than 2 years but did not achieve remission was analyzed by using student t-test and Fisher exact test. Odds ratio (OR) was
calculated to identify predicting factors by logistic regression analysis.
Results : Fifty-three patients enrolled the study (F:M = 43:10). The mean age was 11.1 ± 2.0 years. Twenty patients achieved remission with PTU within 2 years but thirty-three did not. Univariate analysis showed significantly less pulse pressure (p<0.001) and heart rate (p=0.04) in the remission group. Logistic regression analysis identified 4 predictors of early remission; smaller goiter size (OR=0.03, 95%CI 0.002-0.52, p=0.01), older age (OR=2.84, 95%CI 1.23- 6.54, p=0.01), narrow pulse pressure (OR=0.64, 95%CI 0.50-0.82, p<0.001) and low heart rate (OR=0.74, 95%CI 0.58-0.91, p=0.03). Adverse drug reactions of PTU were arthralgia (5%) and
skin rash (3%). No patient had major side effect.
Conclusion : Small goiter size, older age, narrow pulse pressure and low heart rate were predicting factors for remission of pediatric thyrotoxicosis within 2 years of PTU medication.
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บทความที่ส่งมาลงพิมพ์ต้องไม่เคยพิมพ์หรือกำลังได้รับการพิจารณาตีพิมพ์ในวารสารอื่น เนื้อหาในบทความต้องเป็นผลงานของผู้นิพนธ์เอง ไม่ได้ลอกเลียนหรือตัดทอนจากบทความอื่น โดยไม่ได้รับอนุญาตหรือไม่ได้อ้างอิงอย่างเหมาะสม การแก้ไขหรือให้ข้อมูลเพิ่มเติมแก่กองบรรณาธิการ จะต้องเสร็จสิ้นเป็นที่เรียบร้อยก่อนจะได้รับพิจารณาตีพิมพ์ และบทความที่ตีพิมพ์แล้วเป็นสมบัติ ของลำปางเวชสาร
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