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

Abstract

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.

A case of infantile-onset Graves

“…The recommended dose is calculated according to the weight of the thyroid gland and a dose above 150µ Ci/g tissue is recommended. Lower doses increase the risk of thyroid cancer (6,16,19). In the 36-year follow-up of 116 patients who received RAI treatment in their childhood, it was shown that the risk of thyroid cancer related with RAI treatment did not increase.…”

“…In treatment of childhood Graves' disease, the firstline treatment is anti-thyroid drug treatment and RAI and surgical treatment are the other treatment options (6,16). Anti-thyroid drugs act by inhibiting thyroid hormone synthesis at the steps of oxidation and idodine binding (6).…”

“…Anti-thyroid drugs act by inhibiting thyroid hormone synthesis at the steps of oxidation and idodine binding (6). Metimazol is stronger and has a longer action compared to PTU.…”

Autoimmune Disorders Associated to Type 1 Diabetes Mellitus in Children and Adolescents

“…Its frequency increases with age: it is rare before the four years, gradually rises, reaching a peak during adolescence, with a preponderance for female gender (Kaguelidou et al, 2009). The aim of therapy is to reduce the excessive hormone production.…”

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

“…The optimal treatment of hyperthyroidism in children and adolescents remains a matter of debate [16][17][18]. Most patients are initially treated with ATD.…”