Time course to hypothyroidism after fixed-dose radioablation therapy of Graves' disease in children

Nebesio, Todd D.; Siddiqui, Aslam R.; Pescovitz, Ora Hirsch; Eugster, Erica A.

doi:10.1067/mpd.2002.125494

Cited by 56 publications

(45 citation statements)

References 30 publications

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“…Hypothyroidism typically develops by 2–3 months post-treatment [36,37]. When administered doses >150 µCi of 131 I per g of thyroid tissue are administered, hypothyroidism rates are about 95% [2,8,23].…”

Section: Radioactive Iodinementioning

confidence: 99%

“…131 I doses are typically calculated to deliver the desired amount of radiation based on gland size and RAI uptake. Alternatively some centers administer all patients the same fixed dose of 131 I with excellent outcome [36]. To achieve thyroid ablation or hypothyroidism, >150 µCi of 131 I per g of thyroid tissue should be administered [37,38].…”

Section: Radioactive Iodinementioning

confidence: 99%

“…Some centers administer a fixed administered dose of about 15 mCi 131 I to all children [36] rather than individually calculated administered doses. One potential advantage of calculated vs. fixed dosing though is that it may be possible to use lower administered doses of 131 I when the administered dose is calculated, especially when uptake is high.…”

Section: Radioactive Iodinementioning

confidence: 99%

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Pediatric Graves’ Disease: Controversies in Management

Rivkees

2010

Horm Res Paediatr

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Background/Aims: Graves’ disease (GD) is the most common cause of thyrotoxicosis in children and adolescents. Caused by immunologic stimulation of the thyroid-stimulating hormone receptor, lasting remission occurs in only a minority of pediatric patients with GD, including children treated with antithyroid drugs (ATDs) for many years. Thus the majority of pediatric patients with GD will need thyroidectomy or treatment with radioactive iodine (RAI; ¹³¹I). Results: When ATDs are used in children, only methimazole should be used. Propylthiouracil is associated with an unacceptable risk of severe liver injury in children and should never be used as first-line therapy. If remission (defined as normal thyroid function off ATDs) is not achieved after 1 or 2 years of ATD therapy, ¹³¹I or surgery may be considered, with the choice influenced by the age of the individual. When ¹³¹I is used, administered doses should be >150 µCi/g of thyroid tissue. When surgery is performed, near total or total thyroidectomy is recommended. Conclusion: Choosing a treatment approach for childhood GD is often a difficult and highly personal decision. Discussion of the advantages and risks of each therapeutic option is essential to help the patient and family select a treatment option.

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Section: Radioactive Iodinementioning

confidence: 99%

Section: Radioactive Iodinementioning

confidence: 99%

Section: Radioactive Iodinementioning

confidence: 99%

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Pediatric Graves’ Disease: Controversies in Management

Rivkees

2010

Horm Res Paediatr

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“…Some centers administer to all patients the same fixed activity of 131 I with excellent outcome (Nebesio et al, 2002). When children are treated with the dose more than 200-250 Gy/g, hypothyroidism is achieved in nearly 95% of patients (Rivkees & Cornelius, 2003).…”

Section: Toxic Nodular Goiter (Plummer´s Disease)mentioning

confidence: 99%

Hypothyroidism and Radioiodine Therapy

Kraft¹

2012

Hypothyroidism - Influences and Treatments

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Azizi

Amouzegar

2018

Journal of Pediatric Endocrinology and Metabolism

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Background: Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves' disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves' disease. Methods: Between 1981 and 2015, 304 patients aged 5-19 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment. Results: In 304 patients (245 females and 59 males), the mean age was 15.6 ± 2.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7 ± 2.4 years. The mean MMI dose was 4.6 ± 12 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism. Conclusions: Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.

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Time course to hypothyroidism after fixed-dose radioablation therapy of Graves' disease in children

Cited by 56 publications

References 30 publications

Pediatric Graves’ Disease: Controversies in Management

Pediatric Graves’ Disease: Controversies in Management

Hypothyroidism and Radioiodine Therapy

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

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