Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

Cohen, Reuven Zev; Felner, Eric I.; Heiss, Kurt F.; Wyly, J. B.; Muir, Andrew

doi:10.1515/jpem-2015-0333

Cited by 22 publications

(29 citation statements)

References 6 publications

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“…Some centers use RAI in pediatric patients, in which case ablative doses should be used with the aim of rapid hypothyroidism. Other side-effects are not different from those in adults [95]. RAI is contraindicated in pregnancy and during breast feeding, and conception should be postponed until at least 6 months after the therapy.…”

Section: Indications and Applied Rai Dosementioning

confidence: 98%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

678

650

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Graves’ disease (GD) is a systemic autoimmune disorder characterized by the infiltration of thyroid antigen-specific T cells into thyroid-stimulating hormone receptor (TSH-R)-expressing tissues. Stimulatory autoantibodies (Ab) in GD activate the TSH-R leading to thyroid hyperplasia and unregulated thyroid hormone production and secretion. Diagnosis of GD is straightforward in a patient with biochemically confirmed thyrotoxicosis, positive TSH-R-Ab, a hypervascular and hypoechoic thyroid gland (ultrasound), and associated orbitopathy. In GD, measurement of TSH-R-Ab is recommended for an accurate diagnosis/differential diagnosis, prior to stopping antithyroid drug (ATD) treatment and during pregnancy. Graves’ hyperthyroidism is treated by decreasing thyroid hormone synthesis with the use of ATD, or by reducing the amount of thyroid tissue with radioactive iodine (RAI) treatment or total thyroidectomy. Patients with newly diagnosed Graves’ hyperthyroidism are usually medically treated for 12–18 months with methimazole (MMI) as the preferred drug. In children with GD, a 24- to 36-month course of MMI is recommended. Patients with persistently high TSH-R-Ab at 12–18 months can continue MMI treatment, repeating the TSH-R-Ab measurement after an additional 12 months, or opt for therapy with RAI or thyroidectomy. Women treated with MMI should be switched to propylthiouracil when planning pregnancy and during the first trimester of pregnancy. If a patient relapses after completing a course of ATD, definitive treatment is recommended; however, continued long-term low-dose MMI can be considered. Thyroidectomy should be performed by an experienced high-volume thyroid surgeon. RAI is contraindicated in Graves’ patients with active/severe orbitopathy, and steroid prophylaxis is warranted in Graves’ patients with mild/active orbitopathy receiving RAI.

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Section: Indications and Applied Rai Dosementioning

confidence: 98%

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Kahaly¹,

Bartalena²,

Hegedüs³

et al. 2018

Eur Thyroid J

678

650

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“…Eight studies reported that the thyroidectomy was performed by a high-volume surgeon [10, 11, 13-15, 21, 29, 31]. In the study by Cohen et al [23], surgery was performed by a low-volume surgeon. The remaining 13 studies did not report whether thyroidectomies were performed by a low- or a high-volume surgeon [12, 16-20, 22, 24-26, 28, 30].…”

Section: Resultsmentioning

confidence: 99%

“…In the study by Sherman et al [16], 3 patients underwent thyroidectomy after failure of RAI treatment to achieve euthyroidism. Preoperative thyroid hormone levels were reported by Cohen et al [23] and indicated hyperthyroidism (mean free T4 3.2 ng/dL [41.19 pmol/L] and mean total T3 338.7 ng/dL [5.20 nmol/L]). Patients in the study of Peroni et al [11] received preoperative preparation with Lugol’s solution and were euthyroid or hypothyroid as assessed by TSH measurement.…”

Section: Resultsmentioning

confidence: 99%

“…The frequency of permanent hypocalcemia ranged from 0 to 20.0%, with a cumulative reported frequency of 2.5% (36 out of 1,424 patients) (Table 3). The studies by Cohen et al [23] and de Jong et al [20] reported relatively high frequencies of permanent hypocalcemia of 20 and 17.4%, respectively. The other 20 studies reported (very) low frequencies of permanent hypocalcemia, with 13 studies reporting no cases of permanent hypocalcemia [10, 12, 14-17, 19, 22, 24-27, 29].…”

Section: Resultsmentioning

confidence: 99%

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Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Zaat¹,

Derikx²,

Zwaveling-Soonawala³

et al. 2020

Eur Thyroid J

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Background: Graves’ disease (GD) is the most common cause of hyperthyroidism. In children, the overall relapse frequency after treatment with antithyroid drugs is high. Therefore, many pediatric GD patients eventually require thyroidectomy as definitive treatment. However, the postoperative complications of thyroidectomy in pediatric GD patients are poorly reported. Objective: To identify the frequency of short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting short- and long-term postoperative morbidities after thyroidectomy in pediatric GD patients according to the PRISMA guidelines. Results: Twenty-two mainly retrospective cohort studies were included in this review evaluating short- and long-term morbidities in 1,424 children and adolescents. The frequency of transient hypocalcemia was 22.2% (269/1,210), with a range of 5.0–50.0%. The frequency of permanent hypocalcemia was 2.5% (36/1,424), with a range of 0–20.0%. Two studies reported high frequencies of permanent hypocalcemia, 20.0 (6/30) and 17.4% (9/52), respectively. The 20% frequency could be explained by low-volume surgeons in poorly controlled GD patients. Only 21 cases of permanent hypocalcemia were reported in the 1,342 patients included in the other 20 studies (1.6%). Transient and permanent recurrent laryngeal nerve injury were reported less frequently, with frequencies between 0–20.0 and 0–7.1%, respectively. Infection, hemorrhage/hematoma, and keloid development were only rarely reported as postoperative complications. Conclusion: The results of this systematic review suggest that thyroidectomy is a safe treatment option for pediatric GD patients. The minority of patients will experience transient and benign morbidities, with hypocalcemia being the most common transient postoperative morbidity. Permanent postoperative morbidities are relatively rare.

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“…Данные о соотношении экономической эффективности различных методов лечения БГ весьма противоречивы [91][92][93][94]. Во многих центрах 131 I назначается и детям с БГ, при этом в данном случае также рекомендуется использование аблативных активностей 131 I с целью быстрого достижения стойкого гипотиреоза [95]. Терапия 131 I противопоказана при беременности и грудном вскармливании, при этом зачатие не рекомендуется на протяжении минимум 6 месяцев после получения 131 I. Каких-либо данных о том, что терапия радиоактивным йодом сопровождается отдаленными неблагоприятными последствиями на фертильность, риск выкидышей, врожденных аномалий и мертворождения, до настоящего времени нет [96].…”

Section: показания к 131 I и его активностиunclassified

Review of European Thyroid Association Guideline (2018) for the Manage-ment of Graves’ Hyperthyroidism

Фадеев

2020

Clin Exp Thyroid

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Болезнь Грейвса (БГ)-системное аутоиммунное заболевание, характеризующееся инфильтрацией тканей, экспрессирующих рецептор тиреотропного гормона (ТТГ), а также Т-лимфоцитами, специфичными к антигенам щитовидной железы (ЩЖ). При БГ стимулирующие антитела (АТ) активируют рецептор к ТТГ (рТТГ), что приводит к гиперплазии ЩЖ и нерегулируемой гиперпродукции и гиперсекреции тиреоидных гормонов. Диагностика БГ базируется на лабораторном подтверждении тиреотоксикоза, повышении уровня АТ-рТТГ, обнаружении гиперваскуляризации и гипоэхогенности ЩЖ при УЗИ в сочетании с эндокринной орбитопатией (ЭОП). Определение уровня АТ-рТТГ необходимо для дифференциальной диагностики, прогнозирования риска рецидива тиреотоксикоза и при беременности. Тиреотоксикоз при БГ купируется назначением тиреостатиков, которые подавляют синтез тиреоидных гормонов; радикальное лечение подразумевает разрушение ткани ЩЖ при помощи радиоактивного йода (131 I) или ее хирургическое удаление (тиреоидэктомию). Пациентам с впервые выявленной БГ в большинстве случаев назначается терапия тиамазолом (ТМЗ), который рассматривается как препарат первого выбора, сроком 12-18 месяцев. Детям с БГ традиционно рекомендуется более длительный курс терапии ТМЗ-обычно на 24-36 месяцев. Если у пациента сохраняется повышение уровня АТ-рТТГ спустя 12-18 месяцев тиреостатической терапии, она, в части случаев, может быть продолжена с повторным определением АТ-рТТГ еще через 12 месяцев; альтернативой является 131 I или тиреоидэктомия. Женщин, получающих терапию ТМЗ, при планировании беременности или в ее I триместре, рекомендуется перевести на пропилтиоурацил (ПТУ). В случае развития рецидива или сохранения тиреотоксикоза после окончания курса тиреостатической терапии пациенту показано радикальное лечение. Тем не менее в отдельных случаях тиреостатическая терапия может проводиться длительно. Тиреоидэктомию следует доверять специализированным эндокринным хирургам, имеющим достаточный опыт проведения этой операции. Терапия 131 I противопоказана пациентам с тяжелой активной орбитопатией (ЭОП) и должна проводиться на фоне профилактического назначения глюкокортикоидов (ГК) при умеренно активной ЭОП.

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Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

Cited by 22 publications

References 6 publications

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

2018 European Thyroid Association Guideline for the Management of Graves’ Hyperthyroidism

Thyroidectomy in Pediatric Patients with Graves’ Disease: A Systematic Review of Postoperative Morbidity

Review of European Thyroid Association Guideline (2018) for the Manage-ment of Graves’ Hyperthyroidism

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