Book Review

Diseases of the Thyroid in Childhood and Adolescence

N Engl J Med 2007; 357:202-203July 12, 2007

Article

Diseases of the Thyroid in Childhood and Adolescence
(Pediatric and Adolescent Medicine. Vol. 11.) Edited by Gerasimos E. Krassas, Scott A. Rivkees, and Wieland Kiess. 294 pp., illustrated. Basel, Switzerland, Karger, 2007. $196.50. ISBN: 978-3-8055-8205-6

From an adult endocrinologist's perspective, thyroid diseases of childhood fall into two categories. The first category includes well-known thyroid conditions that are commonly seen in adults. The second category consists of rare diseases that physicians who treat adult patients will encounter only many years after a pediatrician has made the diagnosis. This book will provide endocrinologists who treat adults or children with interesting insights into both categories of diseases of the thyroid in children.

The current knowledge and hypotheses about the pathogenesis of autoimmune diseases of the thyroid in children and their possible associations with type 1 diabetes and Turner's syndrome are summarized in two well-structured chapters. Graves' disease in childhood is described well, and the author of the chapter on the condition points out that the persistence of hyperthyroidism in children makes treatment with antithyroid drugs a means of waiting for a radical therapy to be developed. The authors of the chapter that deals with the controversial use of radioactive iodine therapy in children very nicely clarify the issue; the information should make clinicians feel more comfortable using the therapy when it is necessary. The reader will learn that secondhand smoke is a risk factor for Graves' ophthalmopathy in children.

A 6-Week-Old Female Infant with Jaundice Due to Hypothyroidism.

Differentiated thyroid cancer is dealt with in detail, but the repeated statement that children with the disease have a better prognosis than do adults with the disease — even though metastases are more frequent in children — is too broad. The statement might be true if the adults are at least 45 years of age, but the 25-year survival rate in adults younger than 45 years is 98 to 100% — a figure that seems hard to beat.

The chapter on thyroid imaging is detailed and nicely illustrated; it includes scintigrams, ultrasonograms, and scans of positron-emission tomography combined with computed tomography that show various thyroid conditions. However, we are not convinced that radionuclide imaging is any more useful for the evaluation of thyroid nodules in children who have normal levels of thyroid-stimulating hormone than it is for adults. The authors of the chapter on differentiated thyroid cancer mention only the option of exploring thyroid nodules with the use of fine-needle aspiration.

The many consequences of iodine deficiency on the development of children and the complex pathophysiology of the deficiency are detailed in the chapter on iodine intake and thyroid disease. The health consequences of excessive iodine intake are less well known, but the data that suggest a link between iodine excess and autoimmune disease are well presented.

Some chapters address preclinical aspects of thyroid diseases. One chapter is dedicated to the ontogeny of the thyrotropic axis, from the embryologic development of the pituitary to the development of the thyroid gland. The synthesis of thyroid hormones is also discussed in this chapter, and the transport and action of thyroid hormones are addressed in another chapter. Both chapters are useful introductions to the chapters that follow, which include discussions of congenital hypothyroidism, resistance to thyroid hormones, and Pendred's syndrome (congenital deafness, goiters, and hypothyroidism).

The authors of the chapters on rare diseases, such as Pendred's syndrome and resistance to thyroid hormones, summarize the latest research on the molecular aspects of the conditions. The discussion of congenital hypothyroidism points out the difficulties of screening and the need for early treatment and follow-up. The chapter on thyroid disease during pregnancy illuminates the importance of the mother's thyroid hormones for the fetus; this chapter is also useful for gaining an understanding of the consequences that Graves' disease in the mother will have for the fetus. It does not mention, however, the pathogenesis of fetal goiter that is not related to maternal Graves' disease but is instead related to deficient synthesis of thyroid hormones in the fetus. This type of goiter can be detected by ultrasonography and treated in utero to prevent goiter-related dystocia.

A chapter on genetic diseases that affect the thyroid gland directly or indirectly might have been helpful. It also would have been interesting to read a discussion of inherited medullary thyroid cancer, a thyroid C-cell disease (multiple endocrine neoplasia type 2B) that is the main cause of thyroidectomy in young children. A discussion of genetic disorders such as Gardner's syndrome that predispose those who have them to thyroid cancer would also have been welcome. These are minor criticisms of a must-have book that will be very useful to all clinicians who are interested in thyroid disease.

Olivier Chabre, M.D., Ph.D.
Centre Hospitalier Universitaire, Université Joseph Fourier, 38043 Grenoble, France
olivierchabre@chu-grenoble.fr

Patrice Rodien, M.D., Ph.D.
Centre Hospitalier, Université d'Angers, 49000 Angers, France