The Optimal Treatment for Pediatric Graves’ Disease Is Surgery

Lee, James A.; Grumbach, Melvin M.; Clark, Orlo H.

doi:10.1210/jc.2006-1238

Cited by 79 publications

(47 citation statements)

References 26 publications

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“…The optimal treatment of GD in childhood remains a matter of debate [7, 8], and long-term, prospective, randomized clinical studies are still required to compare treatment failure frequencies and the short- and long-term side effects of the different therapeutic options. Current treatment options include ATDs, RAI (iodine-131) and subtotal or near total thyroidectomy.…”

Section: Managementmentioning

confidence: 99%

“…When relapse occurs, thyroidectomy or radioactive iodine (RAI) treatment is considered. However, the most appropriate type of management remains one of the key controversies in pediatric endocrinology and the optimal duration of ATD therapy for the induction of remission has yet to be established [7, 8]. Reliable predictors of relapse after ATD treatment would greatly improve patient management by facilitating the identification of children requiring long-term ATD or early radical treatment [9,10,11].…”

Section: Introductionmentioning

confidence: 99%

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Graves’ Disease in Childhood: Advances in Management with Antithyroid Drug Therapy

Kaguelidou

Carel

Léger³

2009

Horm Res Paediatr

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Graves’ disease is the most common cause of hyperthyroidism in children. Antithyroid drug (ATD) treatment is recommended as the initial treatment, leading to a marked improvement in most symptoms within 1 month of treatment initiation. Remission is achieved in 30% of children after a first course of ATD. Alternative treatments, such as radioactive iodine or thyroidectomy, are considered in cases of relapse, lack of compliance or ATD toxicity. The risk of relapse after a first course of ATD treatment for a median period of 2 years has been shown to be higher in patients with severe biochemical hyperthyroidism at diagnosis, young children and patients of non-Caucasian origin. Relapse risk decreases with the duration of the first course of ATD treatment, highlighting the positive impact of a long period of primary ATD treatment on outcome. The identification of predictive factors has made it possible to stratify patients according to the risk of relapse after ATD treatment, leading to improvements in patient management by facilitating the identification of patients requiring long-term ATD or early alternative therapy. Long-term careful follow-up is needed to determine the efficacy of disease management during childhood.

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Section: Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Graves’ Disease in Childhood: Advances in Management with Antithyroid Drug Therapy

Kaguelidou

Carel

Léger³

2009

Horm Res Paediatr

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“…Complications, such as hypoparathyroidism, vocal cord palsy due to recurrent laryngeal nerve injury and keloid formation, may occur with an estimated incidence of approximately 15%, although such complications are less frequent if the operation is performed by pediatric surgeons with extensive experience (18). For patients with recurrent hyperthyroidism after surgery, treatment with RAI is recommended, because the risk of complications is higher for a second operation (19).…”

Section: Introductionmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

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Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

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“…Surgery may be the optimal definitive treatment in certain patient groups including children under 5 years of age and children with a large goitre ( > 80 g) at diagnosis (34)(35)(36). Complication rates can vary from 15% when performed by paediatric surgeons compared to 4% (p < 0.01) for experienced thyroid surgeons ( > 30 thyroidectomies per year) (37).…”

Section: Patient Stratification To Treatment Modalitymentioning

confidence: 99%

Should radioiodine be the first-line treatment for paediatric Graves’ disease?

West

Cheetham

Dane

2015

Journal of Pediatric Endocrinology and Metabolism

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Background: Debate exists regarding the optimal treatment strategy for paediatric Graves' disease with radioiodine (RAI), and surgery, usually reserved for failure of medical therapy. We present our own experience to introduce a review of the published literature focussing on the predictors of remission after antithyroid drug (ATD) therapy from diagnosis, and discuss whether RAI should be considered as a first-line therapy.

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The Optimal Treatment for Pediatric Graves’ Disease Is Surgery

Cited by 79 publications

References 26 publications

Graves’ Disease in Childhood: Advances in Management with Antithyroid Drug Therapy

Graves’ Disease in Childhood: Advances in Management with Antithyroid Drug Therapy

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Should radioiodine be the first-line treatment for paediatric Graves’ disease?

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