Background: The most prevalent cause of thyrotoxicosis in children is Graves disease (GD), and remission occurs only in a modest proportion of patients. The treatment of GD involves the use of antithyroid medications (ATDs), radioactive iodine (RAI; (131I), or surgical thyroidectomy.
Objective and hypotheses: This presentation will focus on the risks and benefits of the different treatment options for GD.
Method: ATDs are the most common initial therapy for GD. When used, only methimazole should be used due to the risk of liver failure associated with propylthiouracil therapy in children. RAI is an acceptable form of therapy for older children. When used, the goal should be to ablate the thyroid gland. When surgery is performed, total thyroidectomy by an experienced surgeon is recommended.
Results: Long-term data show that rates of spontaneous remission for GD with long-term ATD therapy range from 10 to 40%. With RAI or surgery, more than 95% of children are cured with initial therapy.
Conclusion: Pediatric patients with GD who are not in remission following at least 12 years of methimazole therapy should be considered for treatment with RAI or thyroidectomy. Alternatively, if children are tolerating ATD therapy, ATDs may be used for extended periods. This approach may be especially useful for the child not considered to be a candidate for either surgery or RAI. Individuals on prolonged ATDs therapy (>2 years) should be re-evaluated annually and when transitioning to adulthood.
Funding: This work is supported by the NIH (R01FD003707).
01 Oct 2015 - 03 Oct 2015