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      Pediatric Graves’ Disease: Controversies in Management

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          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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              Thyroid Cancer after Exposure to External Radiation: A Pooled Analysis of Seven Studies


                Author and article information

                Horm Res Paediatr
                Hormone Research in Paediatrics
                S. Karger AG
                November 2010
                02 October 2010
                : 74
                : 5
                : 305-311
                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
                320028 Horm Res Paediatr 2010;74:305–311
                © 2010 S. Karger AG, Basel

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                Pages: 7
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