open access
Definitive treatment of Graves’ disease in children and adolescents
, 2, 1
Affiliations- Department of Nuclear Medicine and Endocrine Oncology, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- The Oncologic and Reconstructive Surgery Clinic, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
open access
Abstract
Graves’ disease (GD) is the most common cause of paediatric hyperthyroidism. In children and adolescents, the clinical GD course is different from that seen in adults, due to low remission rate and high prevalence of adverse events related to treatment with antithyroid drugs (ATDs). Most patients in this group require definitive therapy. As in adults, there are 2 treatment options — thyroid ablation with radioactive iodine (RAI) or surgery with preferred procedure of total thyroidectomy (TT). The choice of definitive therapy depends on many important factors such as the child’s age, effectiveness of the first-line ATD treatment, presence of ATD side effects, presence of large goitre or thyroid nodules, and concomitant diseases.
The following paper provides the current guidelines on GD management in children and compares the efficacy of both definitive treatment methods as well as the acute and long-term complication rates, which must be taken into account when choosing the optimal therapeutic option.
Abstract
Graves’ disease (GD) is the most common cause of paediatric hyperthyroidism. In children and adolescents, the clinical GD course is different from that seen in adults, due to low remission rate and high prevalence of adverse events related to treatment with antithyroid drugs (ATDs). Most patients in this group require definitive therapy. As in adults, there are 2 treatment options — thyroid ablation with radioactive iodine (RAI) or surgery with preferred procedure of total thyroidectomy (TT). The choice of definitive therapy depends on many important factors such as the child’s age, effectiveness of the first-line ATD treatment, presence of ATD side effects, presence of large goitre or thyroid nodules, and concomitant diseases.
The following paper provides the current guidelines on GD management in children and compares the efficacy of both definitive treatment methods as well as the acute and long-term complication rates, which must be taken into account when choosing the optimal therapeutic option.
Keywords
Graves’ disease (GD); antithyroid drugs (ATDs); radioactive iodine (RAI); total thyroidectomy (TT)
About this articleTitle
Definitive treatment of Graves’ disease in children and adolescents
Journal
Issue
Article type
Review paper
Pages
661-665
Published online
2021-10-22
Page views
9544
Article views/downloads
1322
DOI
Pubmed
Bibliographic record
Endokrynol Pol 2021;72(6):661-665.
Keywords
Graves’ disease (GD)
antithyroid drugs (ATDs)
radioactive iodine (RAI)
total thyroidectomy (TT)
Authors
Aleksandra Król
Agnieszka Czarniecka
Barbara Jarząb
References (40)- Vanderpump M. The epidemiology of thyroid disease. Br Med Bull. 2011; 99(1): 39–51.
- Kaguelidou F, Carel JC, Léger J. Graves' disease in childhood: advances in management with antithyroid drug therapy. Horm Res. 2009; 71(6): 310–317.
- Lavard L, Ranløv I, Perrild H, et al. Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988. A nationwide study. Eur J Endocrinol. 1994; 130(6): 565–568.
- Rodanaki M, Lodefalk M, Forssell K, et al. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019; 91(3): 195–202.
- Goday-Arno A, Cerda-Esteva M, Flores-Le-Roux JA, et al. Hyperthyroidism in a population with Down syndrome (DS). Clin Endocrinol (Oxf). 2009; 71(1): 110–114.
- De Luca F, Corrias A, Salerno M, et al. Peculiarities of Graves' disease in children and adolescents with Down's syndrome. Eur J Endocrinol. 2010; 162(3): 591–595.
- Wasniewska M, Corrias A, Messina MF, et al. Graves' disease prevalence in a young population with Turner syndrome. J Endocrinol Invest. 2010; 33(1): 69–70.
- Brown JJ, Datta V, Browning MJ, et al. Graves' disease in DiGeorge syndrome: patient report with a review of endocrine autoimmunity associated with 22q11.2 deletion. J Pediatr Endocrinol Metab. 2004; 17(11): 1575–1579.
- Luo Y, Kawashima A, Ishido Y, et al. Iodine excess as an environmental risk factor for autoimmune thyroid disease. Int J Mol Sci. 2014; 15(7): 12895–12912.
- Borowiec A, Labochka D, Milczarek M, et al. Graves' disease in children in the two decades following implementation of an iodine prophylaxis programme. Cent Eur J Immunol. 2018; 43(4): 399–404.
- Hamed SA, Attiah FA, Abdulhamid SK, et al. Behavioral assessment of children and adolescents with Graves' disease: A prospective study. PLoS One. 2021; 16(4): e0248937.
- Krassas GE, Segni M, Wiersinga WM. Childhood Graves' ophthalmopathy: results of a European questionnaire study. Eur J Endocrinol. 2005; 153(4): 515–521.
- Szczapa-Jagustyn J, Gotz-Więckowska A, Kocięcki J. An update on thyroid-associated ophthalmopathy in children and adolescents. J Pediatr Endocrinol Metab. 2016; 29(10): 1115–1122.
- Collen RJ, Landaw EM, Kaplan SA, et al. Remission Rates of Children and Adolescents with Thyrotoxicosis Treated with Antithyroid Drugs. Pediatrics March 1980, 65 (3) 550-556. 1980; 65(3): 550–556.
- Glaser NS, Styne DM. Organization of Pediatric Endocrinologists of Northern California Collaborative Graves' Disease Study Group. Predicting the likelihood of remission in children with Graves' disease: a prospective, multicenter study. Pediatrics. 2008; 121(3): e481–e488.
- Bahn RS, Burch HB, Cooper DS, et al. American Thyroid Association, American Association of Clinical Endocrinologists. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011; 17(3): 456–520.
- De Luca F, Valenzise M. Controversies in the pharmacological treatment of Graves' disease in children. Expert Rev Clin Pharmacol. 2018; 11(11): 1113–1121.
- Léger J, Carel JC. Arguments for the prolonged use of antithyroid drugs in children with Graves' disease. Eur J Endocrinol. 2017; 177(2): R59–R67.
- Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics. 2003; 111(4 Pt 1): 745–749.
- Marcocci C, Gianchecchi D, Masini I, et al. A reappraisal of the role of methimazole and other factors on the efficacy and outcome of radioiodine therapy of Graves' hyperthyroidism. J Endocrinol Invest. 1990; 13(6): 513–520.
- Kadmon PM, Noto RB, Boney CM, et al. Thyroid storm in a child following radioactive iodine (RAI) therapy: a consequence of RAI versus withdrawal of antithyroid medication. J Clin Endocrinol Metab. 2001; 86(5): 1865–1867.
- Nebesio TD, Siddiqui AR, Pescovitz OH, et al. Time course to hypothyroidism after fixed-dose radioablation therapy of Graves' disease in children. J Pediatr. 2002; 141(1): 99–103.
- Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics. 2003; 111(4 Pt 1): 745–749.
- West JD, Cheetham TD, Dane C, et al. Should radioiodine be the first-line treatment for paediatric Graves' disease? J Pediatr Endocrinol Metab. 2015; 28(7-8): 797–804.
- Boice JD. Radiation-induced thyroid cancer--what's new? J Natl Cancer Inst. 2005; 97(10): 703–705.
- Boice JD. Thyroid disease 60 years after Hiroshima and 20 years after Chernobyl. JAMA. 2006; 295(9): 1060–1062.
- Read CH, Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves' patients. J Clin Endocrinol Metab. 2004; 89(9): 4229–4233.
- Cohen RZ, Felner EI, Heiss KF, et al. Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves' disease. J Pediatr Endocrinol Metab. 2016; 29(3): 319–325.
- Sosa JA, Tuggle CT, Wang TS, et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J Clin Endocrinol Metab. 2008; 93(8): 3058–3065.
- Czarniecka A, Woźniak G, Kropińska A, et al. Surgical approach to differentiated thyroid cancers (DTC) in children [Specyfika leczenia chirurgicznego zróżnicowanych raków tarczycy (ZRT) u dzieci]. Endokrynol Pol. 2019; 70(4): 357–366.
- Drews JD, Cooper JN, Onwuka EA, et al. The relationships of surgeon volume and specialty with outcomes following pediatric thyroidectomy. J Pediatr Surg. 2019; 54(6): 1226–1232.
- Tuggle CT, Roman SA, Wang TS, et al. Pediatric endocrine surgery: who is operating on our children? Surgery. 2008; 144(6): 869–77; discussion 877.
- Hanba C, Svider PF, Siegel B, et al. Pediatric Thyroidectomy. Otolaryngol Head Neck Surg. 2017; 156(2): 360–367.
- Zaat AS, Derikx JPM, Zwaveling-Soonawala N, et al. Thyroidectomy in Pediatric Patients with Graves' Disease: A Systematic Review of Postoperative Morbidity. Eur Thyroid J. 2021; 10(1): 39–51.
- de Jong M, Nounou H, Rozalén García V, et al. Children are at a high risk of hypocalcaemia and hypoparathyroidism after total thyroidectomy. J Pediatr Surg. 2020; 55(7): 1260–1264.
- Baumgarten HD, Bauer AJ, Isaza A, et al. Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg. 2019; 54(10): 1969–1975.
- Chen Y, Masiakos PT, Gaz RD, et al. Pediatric thyroidectomy in a high volume thyroid surgery center: Risk factors for postoperative hypocalcemia. J Pediatr Surg. 2015; 50(8): 1316–1319.
- Machens A, Elwerr M, Schneider R, et al. Disease impacts more than age on operative morbidity in children with Graves' disease after total thyroidectomy. Surgery. 2018; 164(5): 993–997.
- Król A, Krajewska J, Jarzab B. Important considerations when choosing pharmacotherapy for Graves' disease in children. Expert Opin Pharmacother. 2019; 20(14): 1675–1677.
- Wu VT, Lorenzen AW, Beck AC, et al. Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease. Surgery. 2017; 161(1): 147–155.
