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      Pediatric Graves’ Disease: Controversies in Management

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          Abstract

          Background/Aims: Graves’ disease (GD) is the most common cause of thyrotoxicosis in children and adolescents. Caused by immunologic stimulation of the thyroid-stimulating hormone receptor, lasting remission occurs in only a minority of pediatric patients with GD, including children treated with antithyroid drugs (ATDs) for many years. Thus the majority of pediatric patients with GD will need thyroidectomy or treatment with radioactive iodine (RAI; <sup>131</sup>I). Results: When ATDs are used in children, only methimazole should be used. Propylthiouracil is associated with an unacceptable risk of severe liver injury in children and should never be used as first-line therapy. If remission (defined as normal thyroid function off ATDs) is not achieved after 1 or 2 years of ATD therapy, <sup>131</sup>I or surgery may be considered, with the choice influenced by the age of the individual. When <sup>131</sup>I is used, administered doses should be >150 µCi/g of thyroid tissue. When surgery is performed, near total or total thyroidectomy is recommended. Conclusion: Choosing a treatment approach for childhood GD is often a difficult and highly personal decision. Discussion of the advantages and risks of each therapeutic option is essential to help the patient and family select a treatment option.

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          Most cited references 41

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          Antithyroid drugs.

           B. D. Cooper (2005)
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              Thyroid Cancer after Exposure to External Radiation: A Pooled Analysis of Seven Studies

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                Author and article information

                Journal
                HRP
                Horm Res Paediatr
                10.1159/issn.1663-2818
                Hormone Research in Paediatrics
                S. Karger AG
                1663-2818
                1663-2826
                2010
                November 2010
                02 October 2010
                : 74
                : 5
                : 305-311
                Affiliations
                Department of Pediatrics, Yale Pediatric Thyroid Center, Section of Developmental Biology and Endocrinology, Yale University School of Medicine, New Haven, Conn., USA
                Author notes
                *Scott Rivkees, MD, Department of Pediatrics, Yale University, 464 Congress Avenue, New Haven CT 06520 (USA), Tel. +1 203 737 5975, Fax +1 203 737 5972, E-Mail scott.rivkees@yale.edu
                Article
                320028 Horm Res Paediatr 2010;74:305–311
                10.1159/000320028
                20924158
                © 2010 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Pages: 7
                Categories
                Mini Review

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