Scott A. Rivkees
Yale Pediatric Thyroid Center, Department of Pediatrics, Yale University School of Medicine, New Haven, Conn., USA
Current treatment approaches involving antithyroid medications, surgery, and radioactive iodine have been used for more than five decades for the treatment of hyperthyroidism due to Graves' disease in children, adolescents, and adults [1-4]. Although additional studies are needed, the collective observations of thousands of children with Graves' disease have spawned a generous body of literature detailing the natural history of Graves' disease, along with treatment outcome and complications [5, 6]. Based on this reported experience, the following generalizations can be made.
Long-term, spontaneous remission of Graves' disease occurs in less than 30% of children. Thus, the vast majority of children with Graves' disease will need definitive, curative therapy, either in the form of surgery or radioactive iodine.
• There is little evidence that use of antithyroid medications beyond 1 or 2 years increases the likelihood of spontaneous, long-term remission.
• Antithyroid medication use in children and adolescents is associated with minor and major side effects. Although the use of antithyroid medications is standard practice, the use of antithyroid medications involves definite risks.
• Total thyroidectomy is an effective treatment of Graves' disease, with a low rate of disease recurrence. Long-term complications include recurrent laryn-geal nerve paresis in 2% or more of individuals, permanent hypoparathy-roidism in 1% or more, and hypertrophic and non-hypertrophic scars. Surgery is the preferred definitive treatment for the very large thyroid gland and when the individual is considered too young for 131I.
• When used at doses that deliver 150 Gy, or more (>150 |xCi 131I/g thyroid tissue), radioactive iodine is an effective cure for Graves disease and is associated with few acute side effects. Potential long-term adverse side effects, including thyroid cancer and genetic damage, have yet to be observed in individuals treated as children or adolescents with 131I.
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