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      Clinical experience with radioactive iodine in the treatment of childhood and adolescent Graves' disease

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          Abstract

          Background/aims

          Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy.

          Methods

          We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005.

          Results

          The prevalence of GD was higher in females (3:1) and during puberty (for both genders). If no remission was detected during ATD treatment, RAI was indicated when the following criteria were present: non-compliance, relapse, or side effects that were related to ATDs, large goiter, and long-term use of ATDs. The majority of patients developed hypothyroidism within 6 months after RAI. A progressive higher dose regimen was implemented in the last 10 years of the study period. A second RAI dose was necessary in eight cases. During the follow-up period, three pregnancies occurred. One patient with a thyroid nodule and benign cytology was detected.

          Conclusions

          RAI therapy is effective and safe in the treatment of GD in children and adolescents.

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          Most cited references38

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          Comparison of methimazole and propylthiouracil in patients with hyperthyroidism caused by Graves' disease.

          Hirotoshi Nakamura, Shuji Fukata, K. Itoh … (2007)
          Although methimazole (MMI) and propylthiouracil (PTU) have long been used to treat hyperthyroidism caused by Graves' disease (GD), there is still no clear conclusion about the choice of drug or appropriate initial doses. The aim of the study was to compare the MMI 30 mg/d treatment with the PTU 300 mg/d and MMI 15 mg/d treatment in terms of efficacy and adverse reactions. Patients newly diagnosed with GD were randomly assigned to one of the three treatment regimens in a prospective study at four Japanese hospitals. Percentages of patients with normal serum free T(4) (FT4) or free T(3) (FT3) and frequency of adverse effects were measured at 4, 8, and 12 wk. MMI 30 mg/d normalized FT4 in more patients than PTU 300 mg/d and MMI 15 mg/d for the whole group (240 patients) at 12 wk (96.5 vs. 78.3%; P = 0.001; and 86.2%, P = 0.023, respectively). When patients were divided into two groups by initial FT4, in the group of the patients with severe hyperthyroidism (FT4, 7 ng/dl or more, 64 patients) MMI 30 mg/d normalized FT4 more effectively than PTU 300 mg/d at 8 and 12 wk and MMI 15 mg/d at 8 wk, respectively (P < 0.05). No remarkable difference between the treatments was observed in patients with initial FT4 less than 7 ng/dl. Adverse effects, especially mild hepatotoxicity, were higher with PTU and significantly lower with MMI 15 mg/d compared with MMI 30 mg/d. MMI 15 mg/d is suitable for mild and moderate GD, whereas MMI 30 mg/d is advisable for severe cases. PTU is not recommended for initial use.
          Article 0 comments Cited 67 times – based on 0 reviews     Review now
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            Predictors of autoimmune hyperthyroidism relapse in children after discontinuation of antithyroid drug treatment.

            Mireille Castanet, , Juliane Léger … (2008)
            There is debate about how Graves' disease (GD) should be treated in children. The aim of this study was to identify predictors of relapse after antithyroid drug (ATD) treatment in children with GD. We conducted a prospective, multicenter cohort study of children (n = 154) with GD treated with carbimazole for an intended duration of 24 +/- 3 months. After the end of treatment, patients were followed up for at least 2 yr. The primary outcome was hyperthyroidism relapse. Cox's regression analysis was used and a prognostic score was constructed. The overall estimated relapse rate for hyperthyroidism was 59% (95% confidence interval 52-67%) at 1 yr and 68% (95% confidence interval 60-76%) at 2 yr after the end of treatment. Multivariate survival analysis showed that the risk of relapse was higher for patients of non-Caucasian origin [hazard ratio (HR) = 2.54, P < 0.001], with high serum thyroid-stimulating hormone receptor antibodies (HR = 1.21 by 10 U, P = 0.03) and free T(4) (HR = 1.18 by 10 pmol/liter, P = 0.001) levels at diagnosis. Conversely, relapse risk decreased with increasing age at onset (HR = 0.74 per 5 yr, P = 0.03) and duration of first course of ATD (HR = 0.57 per 12 months, P = 0.005). A prognostic score was constructed, allowing the identification of three different risk groups, with 2-yr relapse rates of 46, 77, and 98%. A longer initial duration of euthyroid state with ATD seems to be the only variable related to the risk of hyperthyroidism relapse in children that can be manipulated. Ethnic origin, age, and severity of the disease at diagnosis may guide long-term disease management decisions.
            Article 0 comments Cited 44 times – based on 0 reviews     Review now
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              Age and gender predict the outcome of treatment for Graves' hyperthyroidism.

              A Allahabadia, B Sheppard, Lindsay R. Holder … (2000)
              The response to treatment in Graves' hyperthyroidism is unpredictable, and factors postulated to predict outcome have not generally proved clinically useful or been widely adopted in clinical practice. We audited outcome in 536 patients with Graves' hyperthyroidism presenting consecutively to determine whether simple clinical features predict disease presentation and response to treatment. At presentation males had slightly more severe biochemical hyperthyroidism [free T4: males, 64.3 +/- 3.0 pmol/L (mean +/- SE); females, 61.3 +/- 1.7 (P = 0.45); free T3: males, 24.3 +/- 1.5 pmol/L; females, 21.0 +/- 0.6, (P = 0.04)]. Patients less than 40 yr at diagnosis had more severe hyperthyroidism than patients more than 40 yr old [free T4: 40 yr, 56.7 +/- 2.3 (P = 0.02); free T3: 40 yr, 19.0 +/- 0.9 (P = 0.003)]. Males had a lower remission rate than females after a course of antithyroid medication [19.6% vs. 40%; odds ratio, 0.37; 95% confidence interval (CI), 0.17-0.79; P < 0.01]. Similarly, patients aged less than 40 yr had a lower remission rate than older patients (32.6% vs. 47.8%; odds ratio, 0.53; 95% CI, 0.32-0.87; P = 0.01). One dose of radioiodine cured hyperthyroidism in fewer males than females (47% vs. 74%; P < 0.0001). Logistic regression analysis demonstrated male sex (odds ratio, 2.80; 95% CI, 1.31-5.98; P = 0.008), serum free T4 concentration at diagnosis (odds ratio, 1.02; 95% CI, 1.0-1.04; P = 0.01), and dose of radioiodine administered (odds ratio, 0.99; 95% CI, 0.99-1.00; P = 0.001) were contributing factors associated with failure to respond to a single dose of radioiodine. As males and younger patients are more likely to fail to respond to medical treatment, and male patients are likewise less likely to respond to a single dose of radioiodine, we suggest that those groups with low remission rates should be offered definitive treatment with radioiodine or surgery soon after presentation and that the value of higher initial doses of radioiodine in males be evaluated.
              Article 0 comments Cited 44 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocr Connect
                Journal ID (iso-abbrev): Endocr Connect
                Journal ID (publisher-id): EC
                Title: Endocrine Connections
                Publisher: BioScientifica (Bristol )
                ISSN (Electronic): 2049-3614
                Publication date (Electronic): 05 December 2012
                Publication date Collection: 01 March 2013
                Volume: 2
                Issue: 1
                Pages: 32-37
                Affiliations
                [1 ]Pediatric Endocrinology Unit, Pediatrics Department Irmandade da Santa Casa de Misericórdia de São Paulo 01221-020, São PauloBrazil
                [2 ]Endocrinology and Metabolism, Medicine Department Irmandade da Santa Casa de Misericórdia de São Paulo 01221-020, São PauloBrazil
                [3 ]Nuclear Medicine Laboratory Irmandade da Santa Casa de Misericórdia de São Paulo 01221-020, São PauloBrazil
                Author notes
                Correspondence should be addressed to A N Cury who is now at Faculdade de Ciências Médicas da Santa Casa de São Paulo, Rua Dr Cesério Mota Júnior 61, CEP 01221-020 São Paulo, SP, Brasil Email anamo_cury@ 123456hotmail.com
                Article
                Publisher ID: EC120049
                DOI: 10.1530/EC-12-0049
                PMC ID: 3680965
                PubMed ID: 23781316
                SO-VID: ba7dd029-1990-4e1e-8d74-83238afd70dd
                Copyright © © 2012 The Authors. Published by BioScientifica Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 30 September 2012
                Date accepted : 18 October 2012
                Categories
                Subject: Research

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