Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'

Krassas, Gerasimos E

doi:10.1530/eje.0.1500407

Cited by 21 publications

(21 citation statements)

References 86 publications

(51 reference statements)

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“…This is similar with previous studies [2,7,8,13]. These corneal and extraocular muscle findings may be associated with advanced eye changes in young patients with thyroid diseases.…”

Section: Clinical Signsupporting

confidence: 92%

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Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Jankauskienė¹,

Jarušaitienė²

2017

Thyroid Disorders Ther

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The study of clinical ocular manifestations recruited 105 patients who presented to the Endocrine and Eye clinics of Lithuanian University of Medical Sciences with a history of thyroid diseases. The study comprised two groups of patients: the group I included 36 patients (under 18 years) and the group II-69 (from 18 to 34 years). As the control group, 25 children and 30 young adults of similar age without thyroid, eye and systemic diseases were selected.A comprehensive ophthalmic assessment including patient's complaints, best-corrected Snellen visual acuity, ocular motility, proptosis measurements, intraocular pressure (IOP), eyelid signs (lid aperture, lid retraction), slit lamp and fundus investigation was performed.Our investigation confirms that in children with thyroid diseases ocular symptoms and signs such as upper eyelid retraction, stare and mild proptosis were predominant. Young adults with thyroid diseases complained of foreign body sensation, photosensitivity and pain. There was manifestation of eyelid retraction, eyelid oedema and redness, conjunctival redness and chemosis, eyelid retraction, proptosis and widened palpebral fissure. A small number of young adults with thyroid diseases suffered from severe ocular complications as keratopathy, diplopia.This examination may be useful in early diagnosis of ocular changes in children and young adults with thyroid diseases.

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“…This is similar with previous studies [2,7,8,13]. These corneal and extraocular muscle findings may be associated with advanced eye changes in young patients with thyroid diseases.…”

Section: Clinical Signsupporting

confidence: 92%

“…Although the pediatric population has similar clinical manifestations of GO as in adults, the disorder is less severe in children [2,7,8].…”

Section: Introductionmentioning

confidence: 99%

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Jankauskienė¹,

Jarušaitienė²

2017

Thyroid Disorders Ther

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“…We refrained from doing so because recall bias would heavily affect the obtained data. Nevertheless, there appears to be consensus in the literature that severe GO is uncommon in childhood (3,15). The question thus arises -assuming about equal incidence of GO among children and adults with Graves' hyperthyroidism -of why children have relatively mild GO and adults more severe GO (5).…”

Section: Discussionmentioning

confidence: 99%

“…It is obvious that there remains a big discrepancy in the therapeutic approach of juvenile thyrotoxicosis between the USA and Europe. 131 I therapy has been recommended for a long time in the USA also for children (15,16), but European physicians are reluctant to apply 131 I therapy at young age because of concern for longterm adverse events induced by ionizing irradiation.…”

Section: Discussionmentioning

confidence: 99%

Childhood Graves’ ophthalmopathy: results of a European questionnaire study

Krassas¹,

Segni²,

Wiersinga³

2005

eur j endocrinol

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Objective: Evaluation of the frequency of Graves' ophthalmopathy (GO) and its management in children and adolescents up to 18 years old with Graves' hyperthyroidism. Study design: This was a questionnaire study (QS) among members of the European Thyroid Association and the European Society for Paediatric Endocrinology. Approximately 300 QS were sent to members with electronic addresses and 110 QS were returned from 25 countries: 52 respondents said they had no experience with Graves' disease in this age group, but 67 respondents (23 paediatric and 44 adult endocrinologists) completed the QS. Results: Out of 1963 patients with juvenile Graves' hyperthyroidism seen by respondents in the last 10 years, 641 (33%) had GO; about one-third of GO cases were # 10 years old, and two-thirds were 11-18 years old. The prevalences of GO among juvenile Graves' hyperthyroidism were 36.6, 27.3 and 25.9% in countries in which the smoking prevalence among teenagers was $ 25, 20-25 and , 20% respectively (P , 0.0001 by x 2 test). When confronted with the standard case of a 13-year-old girl with Graves' hyperthyroidism and moderately severe active GO, the diagnostic approach included on average 4.9 biochemical tests (TSH, free thyroxine (FT 4 ) and TSH.R-Ab, 100-88% of respondents) and 2.4 specific investigations (thyroid ultrasound by 69%, orthopsy/visual fields/visual acuity by 64% and orbital magnetic resonance imaging or computed tomography by 63%). Antithyroid drugs were the treatment of choice for 94% of respondents; 70% recommended a wait-and-see policy and 28% corticosteroids for the co-existing GO. In variants of the standard case, a younger age did not affect therapeutic approach very much. Recurrent hyperthyroidism would still be treated with antithyroid drugs by 66%, and with 131 I by 25%. Worsening of GO or active GO when euthyroid would convince about two-thirds of respondents to initiate treatment of GO, preferably with steroids. Conclusion: GO occurs in 33% of patients with juvenile Graves' hyperthyroidism; its prevalence is higher in countries with a higher prevalence of smoking among teenagers. The diagnostic approach to the standard case of a 13-year-old with Graves' hyperthyroidism and moderately severe active GO involves on average five biochemical tests; thyroid as well as orbital imaging is done in 84% of cases. Antithyroid drugs remain the treatment of choice for 94% of respondents, and even so in case of recurrences (66%). For GO, 70% recommend a wait-and-see policy; intervention, preferably with steroids, is advocated by two-thirds of respondents in cases of worsening or still-active eye disease despite euthyroidism.European Journal of Endocrinology 153 515-520

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“…Эндокринная офтальмопатия (1-2-й степени , неактивная) имелась у двух пациентов до проведения РЙТ, после лечения прогрессирования офтальмопатии у пациентов не выявлено. По дан-ным других исследований, начальная стадия и неак-тивная форма эндокринной офтальмопатии не явля-ются противопоказанием к РЙТ [17,18]. Таким об-разом, наше исследование не подтвердило наличия значимых побочных эффектов РЙТ в лечении ДТЗ у детей и подростков в ближайшем и отдаленном пери-оде наблюдения.…”

Section: результаты леченияunclassified

Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

et al. 2017

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Диффузный токсический зоб (болезнь Грейвса) является наиболее частой причиной гипертиреоза у детей и подростков. Методами выбора в лечении являются терапия тиреостатиками, оперативное вмешательство, радиойодтерапия (РЙТ). Изучение эффективности и безопасности РЙТ тиреотоксикоза у детей и подростков является актуальной задачей. В настоящей статье мы суммировали результаты серии клинических наблюдений и проанализировали эффективность и безопасность РЙТ диффузного токсического зоба (ДТЗ) у детей и подростков. Мы наблюдали всего 25 пациентов в воз-расте от 11 до 17 лет (в среднем 14,8 года) с ДТЗ. Десяти пациентам в 2016 г. РЙТ (активности 550-920 мБк) была про-ведена в ФГБУ ЭНЦ. Период в этой подгруппе наблюдения -6-11 мес. Вторая подгруппа (15 пациентов) была пролече-на в радиологическом отделении города Нижнего Тагила (Свердловская область) в период с августа 2005 г. по сентябрь 2012 г. Период наблюдения составил от 3,5 до 11,5 лет (в среднем 8,54 ± 2,87 года). РЙТ была проведена без каких-либо осложнений, непосредственных или отдаленных. У двух пациентов, имевших признаки эндокринной офтальмопатии в неактивной фазе, не возникло ухудшения глазных симптомов после РЙТ. У 17 (68%) из 25 пациентов через 6 мес после РЙТ развился гипотиреоз. В одном случае -эутиреоз. В остальных 7 наблюдениях зарегистрирован рецидив тиреоток-сикоза. Подгруппы пациентов не различались по возрасту, соотношению по полу, объему щитовидной железы и титру антител к рецептору тиреотропного гормона, но отличались по величине лечебной активности 131 I (подгруппа ЭНЦ -550-920 МБк; подгруппа из Нижнего Тагила -168-400 МБк). При этом эффективность лечения значимо не отличалась (p = 0,99): 68 и 73% соответственно. Таким образом, РЙТ является эффективным, хорошо переносимым и безопасным методом лечения ДТЗ у детей и подростков. Необходимо продолжить исследование в более многочисленной выборке, при больших сроках наблюдения, а также совершенствовать эффективность РЙТ. Клю че вые сло ва: радиойодтерапия, диффузный токсический зоб, дети, подростки, эффективность, безопасность.There are three methods in treatment of Graves' disease in children and adolescents -antithyroid drugs, surgery and radioiodine therapy (RIT). However, treatment protocol of children and adolescents doesn't exist. In the present case series study we have evaluated the effectiveness and safety of RIT in children and adolescents. We have observed totally 25 patients in age 11-17 years old (mean 14.8 years) with Graves' disease. Ten patients were treated with RIT in Endocrinology Research Centre (Moscow) in 2016 year with activities 550-920 MBq. Follow-up period varied 6-11 months in this subgroup. The second subgroup (15 patients) was treated in radiology department in Nijniy Tagil rural hospital (Ural region) in the period 2005-2012 years. Follow-up period varied 3.5-11.5 years (mean 8.5 years). RIT was executed in all patients without any complications, direct or long-term. In two patients having endocrine ophtalmopathy in non-active phase it was no any signs of worsening in resul...

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Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'

Abstract: Three treatment modalities are

Cited by 21 publications

References 86 publications

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Clinical Ocular Features in Children and Young Adults with Thyroid Diseases

Childhood Graves’ ophthalmopathy: results of a European questionnaire study

Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

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