Radioactive iodine for the treatment of Graves disease in paediatric age: the experience of a tertiary centre and literature review (original) (raw)
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Journal of Pediatric Endocrinology and Metabolism, 2019
IntroductionOnly about 30% of pediatric patients with Graves’ hyperthyroidism achieve remission with medical therapy, and therefore radioactive iodine (RAI) therapy is often used as a definitive treatment. Although the goal of RAI is permanent hypothyroidism, this is not consistently achieved. We conducted a chart review to determine the factors associated with the success of RAI. We also tried to determine optimal follow-up post RAI and if there was an optimal L-thyroxine dose that would normalize the hypothyroid state quickly.MethodsThis is a retrospective chart review of Graves’ patients who underwent RAI between 2008 and 2017. We included age, sex, time from diagnosis, thyroid gland size, total dose of I-131 and dose in μCi/g of thyroid tissue. Patients were grouped based on outcome and analyzed using univariate and multivariate logistic regression. Follow-up thyroid levels post RAI and after starting l-thyroxine were analyzed.ResultsThere were 78 ablations including six repeat ...
Endocrine connections, 2013
Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy. We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005. The prevalence of GD was higher in females (3:1) and during puberty (for both genders). If no remission was detected during ATD treatment, RAI was indicated when the following criteria were present: non-compliance, relapse, or side effects that were related to ATDs, large goiter, and long-term use of ATDs. The majority of patients developed hypothyroidism within 6 months after RAI. A progressive higher dose regimen was implemented in the last 10 years of the study period. A second RAI dose was necessary in eight cases. During the follow-up peri...
Success rate of radioactive iodine treatment for children and adolescent with hyperthyroidism
Journal of Endocrinological Investigation, 2020
Purpose To assess the success rate of first dose radioiodine for treatment of hyperthyroidism in children and adolescent. Methods This is a retrospective data analysis of children and adolescent with hyperthyroidism who received radioiodine (RAI) therapy from January 2013 to December 2017. Age, gender, family history of hyperthyroidism, duration of anti-thyriod drugs (ATDs) treatment, rapid turnover status, 2 h and 24 h I-131 radioiodine uptake (RAIU), thyroid volume, and treatment dose were also analyzed. The goal of RAI therapy was to achieve hypothyroidism within 3-6 months after treatment. Treatment result was evaluated at 6 months after treatment and divided into 2 groups: treatment success (hypothyroid and euthyroid) and treatment failure (hyperthyroid). The same parameters were compared between both groups. Results 32 hyperthyroid patients, 26 female with mean age at treatment of 13.84 ± 1.83 years. All patients had prior treatment with ATDs, with a median treatment duration of 32.5 months (range 2-108). The median estimated thyroid gland size was 24.62 g, range 9.29-72.8. RAI doses ranged from 4.1 to 29.9 mCi (median dose = 7.54 mCi). Significant difference in 24-h I-131 uptake and RI status was demonstrated. Successful treatment rate after single dose of therapeutic I-131 was 65.63%. Conclusion With the I-131 dose of 220 μCi/g of thyroid tissue, successful treatment rate after single dose of therapeutic I-131 was 65.63%. RAI therapy with I-131 dose of 250-400 μCi/g of thyroid tissue might be suitable in patients with medical failure from ATDs. Possible role of RI as the predictor for RAI therapy failure are needed to investigate in both adult and children clinical settings.
Management of thyrotoxicosis in children and adolescents: 35 years' experience in 304 patients
Journal of pediatric endocrinology & metabolism : JPEM, 2018
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. 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. 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 ...
Radioactive Iodine for Thyrotoxicosis in Childhood and Adolescence: Treatment and Outcomes
Journal of Clinical Research in Pediatric Endocrinology, 2013
duration of antithyroid drug (ATD) treatment, 24-hour I-131 uptake, thyroid weight, total dose and number of treatments with I-131, and thyroid status at 6 months after treatment were recorded. Results: The outcomes of 27 patients (85.2% female, 14.8% male) treated with radioactive iodine were analyzed to assess the effectiveness of therapy as related to dose and gland size. All children and adolescents received 150 µCi of I-131/g of thyroid tissue (n=27). Six 6 months after treatment, 44.5% of the patients were hyperthyroid, 14.8% were euthyroid, and 40.7% were hypothyroid. Of the 12 cases with hyperthyroidism, 2 cases needed a second dose of I-131 treatment, and they finally reached a hypothyroid state. The patients were classified into 2 groups according to treatment success (euthyroid and hypothyroid) and treatment failure (hyperthyroid). There were no significant differences in age, gender, duration of ATD treatment, 2-and 24-hour I-131 uptake, thyroid weight, and total I-131 dose between these two groups. Conclusions: Radioiodine treatment is safe and effective for thyrotoxicosis in childhood and adolescence. It is suitable as a good second-line therapy for patients with severe complications, those who show poor compliance, and those who fail to respond to ATD treatment. .
Journal of Internal Medicine, 1995
Objectives. To investigate the long-term effect of radioactive iodine (13'1) on thyroid function and size in patients with Graves' disease. Setting. Outpatient clinic in Herlev Hospital. Subjects. One hundred and seventeen consecutive patients (104 women) with Graves' disease selected for I 3 ' I treatment and followed for a minimum of 12 months (range 1-10 years, median 5 years). Interventions. l n ' I dose was calculated based on thyroid volume and 24-h I3'I uptake. Main outcome measures. Standard thyroid function variables and ultrasonically determined thyroid volume before treatment as well as 0.75, 1.5. 3, 6 and 12 months after treatment, and then once a year were investigated. Results. Seventy-eight patients were cured by one ""I dose and 30 by two doses, while the remaining nine patients received additional doses (range one to five doses, median one dose). Within one year, 2 5 % developed hypothyroidism, and hereafter, hypothyroidism developed at a constant rate of 3% per year independent of antithyroid pretreatment. The cumulative 10-year risk of hypothyroidism was 60%. Initial median thyroid volume was 33 mL (range 9-106 mL). At 12 months after the last I3'I dose, median thyroid volume was reduced to 14 mL (range 6-36 mL) (P < 0.00001). The median reduction being 58% (range 0-800/,), hereafter no further reduction occurred. A significant reduction in thyroid volume was also noted in patients needing subsequent I3'I doses and in those developing hypothyroidism within the first year. Conclusions. l 3 l I normalizes thyroid volume in patients with Graves' disease. Hypothyroidism seems an inevitable end result of this treatment. The present study suggests that it will be impossible to modify 13'1 therapy in a way to achieve both early control of hyperthyroidism and a low incidence of hypothyroidism.
Managing paediatric Graves' disease
International Journal of Research in Medical Sciences, 2014
INTRODUCTION Graves' disease is the most common cause of hyperthyroidism in children, adolescents and adults. 1 Graves 'disease accounts for 10-15% of all childhood thyroid diseases. As in adults, Graves' disease occurs more frequently in female subjects. It may occur at any age during childhood, but it increases in frequency with age .3. The incidence is 0.1 per 100,000 person per year in young children to 3 per 100,000 person per year in adolescents. 3 Graves' disease occur more frequently in children who are suffering from other autoimmune diseases like rheumatoid arthritis, SLE, Pernicious anaemia and type 1 diabetes. 4 CAUSES OF HYPERTHYROIDISM IN CHILDREN Primary hyperthyroidism Graves` disease Toxic adenoma Autoimmune neonatal hyperthyroidism(passage of maternal TRAbs from placenta) Iodine induced hyperthyroidism (iodine, radio contrast agents) Activating mutations of TSH receptor gene. Somatic activating mutation of Gsα (McCune Albright syndrome) Secondary hyperthyroidism TSH secreting pituitary adenoma Thyroid hormone resistance syndrome Thyrotoxicosis without hyperthyroidism Sub-acute thyroiditis Silent thyroiditis Thyrotoxicosis facticia (ingestion of excess thyroid hormone or tissue) PATHOPHYSIOLOGY OF GRAVES' DISEASE A complex interaction of genetic, environmental and immune factors play an important role in the ABSTRACT Graves' disease is the most common cause of hyperthyroidism in children. Anti-thyroid drug treatment with carbimazole or its active metabolite methimazole is offered as first line initial treatment but it induces remission in only 30%of children. Propylthiouracil is not recommended in children because of its association with severe hepatic toxicity. For those who relapse after ATD, radioactive iodine can be offered as definitive therapy except in cases with severe Graves' ophthalmopathy or patients with large goitre who are the candidates for surgery. Total (or near total) thyroidectomy is the surgical procedure of choice for treating paediatric patients with Graves' disease as it reduces the risk of recurrent hyperthyroidism which was seen in patients undergoing subtotal or partial thyroidectomy.
Frontiers in Endocrinology, 2021
Background/purposeGraves’ disease (GD) is the most common cause of thyrotoxicosis in children and adolescents. There is some debate regarding the optimal treatment and predicting factors of remission or relapse in children and adolescents with GD. In this study, we report a retrospective study of 195 children and adolescents with GD treated at a single tertiary institution in Korea.MethodsThis study included children and adolescents with GD diagnosed before 19 years of age from January of 2000 to October of 2020. The diagnosis of GD was based on clinical features, high thyroxine (FT4), suppressed thyroid-stimulating hormone, and a positive titer of thyrotropin receptor antibodies. Remission was defined as maintenance of euthyroid status for more than six months after discontinuing antithyroid drug (ATD).ResultsA total of 195 patients with GD were included in this study. The mean age at diagnosis was 12.9 ± 3.2 years, and 162 patients (83.1%) were female. Among all 195 patients, five...