A 36-Year Retrospective Analysis of the Efficacy and Safety of Radioactive Iodine in Treating Young Graves’ Patients

Abstract

This report details the 26- and 36-yr outcomes of 116 patients under the age of 20 yr with Graves' disease who were treated with radioiodine between 1953 and 1973. Contacted by telephone and mail in 1991-1992, 107 of them supplied personal historical data, and their physicians furnished interval histories, physical examinations, and laboratory data. This was repeated in 2001-2002, with 98 of them being contacted. At the time of treatment, the patients' ages ranged between 3 yr, 7 months and 19 yr, 9 months. Six were less than 6 yr of age, 11 were between 6 and 11 yr, 45 were between 11 and 15 yr, and 45 were between 16 and 19 yr. The average length of follow-up in 1991-1992 was 26.1 yr; that in 2001-2002 was 36.2 yr. None of the patients developed cancer of the thyroid or leukemia. Early on, when the objective of treatment was euthyroidism, the dose of radioiodine was low, and retreatment was frequently needed. Later, the doses used were increased. Over time, all but two patients became hypothyroid. Pregnancies did not result in an unusual number of congenital anomalies or spontaneous abortions. Treating young people with Graves' disease with radioiodine is safe and effective over the long term.

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

“…Most patients develop hypothyroidism following ablative therapy [7]. In the present study, 20% of patients had to use radioiodine twice and 66% of those treated with radioiodine became hypothyroid.…”

“…For those patients who do not achieve remission after approximately 2 years' treatment with ATD therapy, experienced side effects or had difficulties with compliance, ablative therapy with radioiodine or surgery should be offered [6][7][8]11]. Some families and patients prefer radioiodine ablation over thyroid surgery due to concerns over the cosmetic appearance of a surgical scar.…”

“…Few topics have raised greater controversy than the management of Graves' disease in children and adolescents, and only a few institutions have been able to gather enough experience to adequately provide supported guidelines for treatment [5][6][7]. There is no specific cure for the illness, and potential complications are associated with one of the three therapeutic options: antithyroid drugs (ATD), radioiodine and surgery [1][2][3][4][5][6][7]. Medical therapy, frequently chosen as the initial treatment, is associated with side effects and a high relapse rate even after prolonged therapy [6,8].…”

“…Medical therapy, frequently chosen as the initial treatment, is associated with side effects and a high relapse rate even after prolonged therapy [6,8]. Although radioiodine therapy achieves high rates of remission [7][8][9][10][11], concerns linger about the safety of radioiodine [12] in children and adolescents and the oncogenic and genetic damage potentials after such therapy [13,14]. Subtotal thyroidectomy is a complex surgical procedure that can result in recurrent laryngeal nerve damage and hypoparathyroidism, although it may achieve high rates of remission [15].…”

An unusual complication of radioactive iodine therapy-stroke

“…Side effects of RAI treatment are transient hyperthyroidism, hypothyroidism, thyroid swelling, sialadenitis, immunogenic effect, carcinogenicity, and teratogenicity. Absolute contraindications to RAI are pregnancy, lactation, planning pregnancy, moderate to severe opthalmopathy, inability to comply with radiation safety regulation [3]. We are presenting a rare case of stroke associated with post RAI thyrotoxicosis.…”