Radioactive iodine therapy for pediatric Graves’ disease: a single-center experience over a 10-year period

Kaplowitz, Paul B.; Jiang, Jiji; Vaidyanathan, Priya

doi:10.1515/jpem-2019-0316

Cited by 12 publications

(10 citation statements)

References 12 publications

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“…1). Based on the quality assessment, the quality of 2 of the included studies was rated as good [14, 15], 18 studies as fair [16-33], and 3 studies as reasonable [34-36]. As reported RAI treatment protocols differed between studies or changed over time (including the treatment goal: aiming for eu- or hypothyroidism) and individual patient data were lacking, we were unable to perform a meta-analysis calculating the optimal iodine-131 activity aiming for hypothyroidism.…”

Section: Resultsmentioning

confidence: 99%

“…Extracted data on the applied iodine-131 activity (converted to megabecquerel [MBq]), the efficacy of RAI treatment, and the short- and long-term side effects are shown in Table 1. Seventeen studies used a calculated activity of RAI [17, 19-33, 36], and 2 studies a fixed activity of RAI [14, 15]. In 4 studies, it was not clear how the activity of RAI was determined [16, 18, 34, 35].…”

Section: Resultsmentioning

confidence: 99%

“…Based on the 2 studies reporting the effects of different RAI activities aiming at hypothyroidism, an activity of 11 MBq but possibly a little >15 MBq per gram of thyroid tissue leads to an efficacy of 85–94% [25, 28]. In addition, Kaplowitz et al [33] stated that a higher RAI activity was associated with a higher likelihood of hypothyroidism (8.95 vs. 7.84 MBq per gram of thyroid tissue; p = 0.013). Interestingly, none of the studies aiming at hypothyroidism reached 100% efficacy, meaning that a minority of patients may require a second RAI treatment to achieve hypothyroidism.…”

Section: Discussionmentioning

confidence: 99%

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The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

Lutterman¹,

Zwaveling-Soonawala²,

Verberne³

et al. 2021

Eur Thyroid J

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Background: Graves’s disease (GD) is the most common cause of hyperthyroidism. Maximal 30% of pediatric GD patients achieve remission with antithyroid drugs. The majority of patients therefore require definitive treatment. Both thyroidectomy and radioactive iodine (RAI) are often used as definitive treatment for GD. However, data on efficacy and short- and long-term side effects of RAI treatment for pediatric GD are relatively scarce. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting the efficacy or short- and long-term side effects of RAI treatment in pediatric GD. Results: Twenty-three studies evaluating 1,283 children and adolescents treated with RAI for GD were included. The treatment goal of RAI treatment changed over time, from trying to achieve euthyroidism in the past to aiming at complete thyroid destruction and subsequent hypothyroidism in the last 3 decades. The reported efficacy of a first RAI treatment when aiming at hypothyroidism ranged from 42.8 to 97.5%, depending on the activity administered. The efficacy seems to increase with higher RAI activities. When aiming at hypothyroidism, both short- and long-term side effects of treatment are very rare. Long-term side effects were mainly seen in patients in whom treatment aimed at achieving euthyroidism. Conclusion: RAI is a safe definitive treatment option for pediatric GD when aiming at complete thyroid destruction. When aiming at hypothyroidism, the efficacy of treatment seems to increase with a higher RAI activity. Prospective studies are needed to determine the optimal RAI dosing regimen in pediatric GD.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

Lutterman¹,

Zwaveling-Soonawala²,

Verberne³

et al. 2021

Eur Thyroid J

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“…Most patients remained hyperthyroid 1 month post RAI, but by 3 months, the majority became hypothyroid. Testing at 2-3 months after RAI is most helpful for confirming the response to RAI (41). In a retrospective and multifactorial data analysis of 32 children and adolescents with hyperthyroidism who had prior treatment with ATDs, the authors concluded that RAI therapy with an I-131 dose of 250-400 μCi/g of thyroid tissue might be suitable in patients with medical failure from ATDs (42).…”

Section: Definitive Treatment (Surgery Vs Radioiodine)mentioning

confidence: 99%

Hyperthyroidism in adolescents

Niedziela

2021

Endocrine Connections

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The term 'hyperthyroidism' refers to a form of thyrotoxicosis due to inappropriately high synthesis and secretion of thyroid hormone(s) by the thyroid. The leading cause of hyperthyroidism in adolescents is Graves’ disease (GD); however, one should also consider other potential causes, such as toxic nodular goiter (single or multinodular) and other rare disorders leading to excessive production and release of thyroid hormones. The term 'thyrotoxicosis' refers to a clinical state resulting from inappropriately high thyroid hormone action in tissues, generally due to inappropriately high tissue thyroid hormone levels. Thyrotoxicosis is a condition with multiple aetiologies, manifestations, and potential modes of therapy. By definition, the extrathyroidal sources of excessive amounts of thyroid hormones, such as iatrogenic thyrotoxicosis, factitious ingestion of thyroid hormone, or struma ovarii, do not include hyperthyroidism. The aetiology of hyperthyroidism/and thyrotoxicosis should be determined. Although the diagnosis is apparent based on the clinical presentation and initial biochemical evaluation, additional diagnostic testing is indicated. This testing should include (1) measurement of TSHR antibodies (TRAb); (2) analysis of thyroidal echogenicity and blood flow on ultrasonography; or (3) determination of radioactive iodine uptake (RAIU). A 123I or 99mTc pertechnetate scan is recommended when the clinical presentation suggests toxic nodular goiter. Different treatment modalities might be preferred to achieve euthyroidism and to avoid potential risks from the treatment. The vast majority of patients with thyroid disorders require life-long treatment; therefore, the collaboration of different specialists is warranted to achieve these goals and improve patients’ quality of life.

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“…Kaplowitz и соавт. опубликовали в 2019 г. результаты лечения радиоактивным йодом 78 детей и подростков (от 6 до 19 лет) с БГ [18]. Гипотиреоз был достигнут в 73% случаев.…”

Section: обсуждение основного результата исследованияunclassified

Predictors of the efficacy of radioiodine therapy of Graves’ disease in children and adolescents

Rumyantsev

Saenko

Dzeytova

et al. 2020

Probl Endokrinol (Mosk)

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RATIONALE: Insufficient world–wide clinical experience in radioiodine therapy (RIT) for Graves’ disease (GD) in children and adolescents, and limited knowledge of the predictors of RIT efficacy.AIMS: Analysis and identification of the most significant predictors of the efficacy of RIT in children and adolescents with Graves’ disease.MATERIALS AND METHODS: A total of 55 patients (48 females and 7 males) aged from 8 to 18 years receiving primary RIT for GD were enrolled. RIT planning was based on the dosimetric method. Analyzed parameters included gender, age, ultrasound thyroid volume before and 6 months after treatment, the presence of endocrine ophthalmopathy, duration of antithyroid drug (ATD) therapy, relapse of thyrotoxicosis after ATD dose reduction, blood fT3, fT4 and TSH levels initially and at 1, 3, 6 months after treatment, TSH receptor Ab initially and at 3 and 6 months after treatment, thyroid 99mTc–pertechnetate uptake at 10–20 minutes (%), maximum thyroid 131I uptake (%), specific 131I uptake (MBq/g) and therapeutic 131I activity (MBq). Fisher exact test, non–parametric Mann–Whitney test, Wilcoxon signed–rank test, logistic regression modelling, ROC–analysis, proportional hazard model (the Cox regression), the Kaplan–Meier method and log–rank test were used for statistical analysis as appropriate.RESULTS: Six months after RIT, hypothyroidism was achieved in 45 (81.8%), euthyroid state – in 2 (3.6%), and in 8 (14.6%) patients thyrotoxicosis persisted. On univariate statistical analysis, the smaller thyroid volume, higher fT4 and lower TSH receptor Ab levels, lower 99mTc–pertechnetate uptake and higher specific 131I uptake were associated with hypothyroidism. On multivariate logistic regression analysis, the older patient’s age (p=0.011), smaller thyroid volume (p=0.003) and higher fT4 (p=0.024) were independent predictors of RIT efficacy. Thyroid volume was also the only variable associated with achievement of hypothyroidism in time after RIT (p=0.011).CONCLUSION: The efficacy of dosimetry–based RIT in children and adolescents with GD 6 months after treatment was 81.2%. Older patients’ age, smaller thyroid volume and higher fT4 level were independent predictors of therapy success. Smaller thyroid volume was also a predictor of the favorable time–related outcome. Statistical models obtained in this work may be used to prospectively estimate the chance of efficient RIT for GD in pediatric patients.

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Radioactive iodine therapy for pediatric Graves’ disease: a single-center experience over a 10-year period

Cited by 12 publications

References 12 publications

The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

The Efficacy and Short- and Long-Term Side Effects of Radioactive Iodine Treatment in Pediatric Graves’ Disease: A Systematic Review

Hyperthyroidism in adolescents

Predictors of the efficacy of radioiodine therapy of Graves’ disease in children and adolescents

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