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Radioiodine treatment for pediatric hyperthyroid Grave’s disease

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Abstract

Grave’s disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatment for pediatric GD includes (1) antithyroid drugs (ATD), (2) radioiodine, and (3) thyroidectomy. Yet, the optimal therapy remains controversial. We collected studies from all electronically available sources as well as from conferences held in China. All studies using radioiodine and/or ATD and/or thyroidectomy were included. Information was found on 1,874 pediatric GD patients treated with radioiodine, 1,279 patients treated with ATD and 1,362 patients treated surgically. The cure rate for radioiodine was 49.8%; the incidence of hypothyroidism, 37.8%; of relapse, 6.3%; of adverse effects, 1.55%; and of drop outs, 0.6%. These data show that radioiodine treatment is safe and effective in pediatric GD with significant lower incidence of relapse and adverse effects but significantly higher incidence of hypothyroidism as compared with both ATD and thyroidectomy. For the time being, radioiodine treatment for pediatric GD remains an excellent first-line therapy and a good second-line therapy for patients with ATD failure, severe complications, or poor compliance.

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References

  1. 1.

    Amrhein JA, Kenny FM, Ross D (1970) Granulocytopenia, lupus-like syndrome, and other complications of propylthiouracil therapy. J Pediatr 76:54–63

  2. 2.

    Bacon GE, Lowery GH (1965) Experience with surgical treatment of thyrotoxicosis in children. J Pediatr 67:1–5

  3. 3.

    Bal C, Kumar A, Tripathi M et al (2005) High-dose radioiodine treatment for differentiated thyroid carcinoma is not associated with change in female fertility or any genetic risk to the offspring. Int J Radiat Oncol Biol Phys 63:449–455

  4. 4.

    Barnes HV, Blizzard RM (1977) Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr 91:313–320

  5. 5.

    Barrio R, Lopez-Capape M, Martinez-Badas I et al (2005) Graves’ disease in children and adolescents: response to long-term treatment. Acta Paediatr 94:1583–1589

  6. 6.

    Becker DV, Hurley JR (1971) Complications of radioiodine treatment of hyperthyroidism. Semin Nucl Med 1:442–460

  7. 7.

    Bergman P, Auldist AW, Cameron F (2001) Review of the outcome of management of Graves’ disease in children and adolescents. J Paediatr Child Health 37:176–182

  8. 8.

    Bhadada S, Bhansali A, Velayutham P et al (2006) Juvenile hyperthyroidism: an experience. Indian Pediatr 43:301–307

  9. 9.

    Buckingham BA, Costin G, Roe TF et al (1981) Hyperthyroidism in children. A reevaluation of treatment. Am J Dis Child 135:112–117

  10. 10.

    Cheetham T, Wraight P, Hughes IA et al (1998) Radioiodine treatment of Graves’ disease in young people. Horm Res 49:258–262

  11. 11.

    Chen XH, Shen ZG, Zheng GQ et al (2000) The surgical treatment of hyperthyroidism in patients aged under 18 years. Chinese Journal of General Surgery 9:527–529

  12. 12.

    Chen DY, Chen TH (2005) Comparison of efficacy of 131I and antithyroid drugs in the treatment of Graves’ disease in children. Chin J Pediatr 143:507–509

  13. 13.

    Chen HH, Liao N (2007) The analysis of therapeutic effects of radioiodine for Grave’s disease in children. Chinese Journal of Misdiagnostics 7:2577–2578

  14. 14.

    Clark JD, Gelfand MJ, Elgazzar AH (1995) Iodine-131 therapy of hyperthyroidism in pediatric patients. J Nucl Med 36:442–445

  15. 15.

    Crile G Jr, Schumacher OP (1965) Radioactive iodine treatment of Graves’ disease. Results in 32 children under 16 years of age. Am J Dis Child 110:501–504

  16. 16.

    Deng B, Xiao H, Chen HM et al (2006) The analysis of therapeutic effects of radioiodine treatment for pediatric patients with Grave’s disease and incidence of hypothyroidism. Journal of Chinese Physician 18:1136–1137

  17. 17.

    Dotsch J, Siebler T, Hauffa BP et al (2000) Diagnosis and management of juvenile hyperthyroidism in Germany: a retrospective multicenter study. J Pediatr Endocrinol Metab 13:879–885

  18. 18.

    Dou ZX, Wang J, Wang GY et al (2004) Effect of bilateral subotal thyroidectomy for juvenile hyperthyroidism. Journal of Applied Clinical Pediatrics 19:146–147

  19. 19.

    Fisher DA (1994) Graves’ disease in children. Curr Ther Endocrinol Metab 5:71–74

  20. 20.

    Freitas JE, Swanson DP, Gross MD et al (1979) Iodine-131: optimal therapy for hyperthyroidism in children and adolescents? J Nucl Med 20:847–850

  21. 21.

    Goldsmith RE (1972) Radioisotope therapy for Graves’ disease. Mayo Clin Proc 47:953–961

  22. 22.

    Gruneiro-Papendieck L, Chiesa A, Finkielstain G et al (2003) Pediatric Graves’ disease: outcome and treatment. J Pediatr Endocrinol Metab 16:1249–1255

  23. 23.

    Hamburger JI (1985) Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab 60:1019–1024

  24. 24.

    Hawkins MM, Draper GJ, Smith RA (1989) Cancer among 1348 offspring of survivors of childhood cancer. Int J Cancer 43:975–978

  25. 25.

    Hawkins MM (1991) Is there evidence of a therapy related increase in germ cell mutation among childhood cancer survivors? J Natl Cancer Inst 83:1643–1650

  26. 26.

    Hayek A, Chapman EM, Crawford JD (1970) Long-term results of treatment of thyrotoxicosis in children and adolescents with radioactive iodine. N Engl J Med 29;283:949–953

  27. 27.

    Hayles AB, Kennedy RL, Beahrs OH et al (1959) Exophthalmic goiter in children. J Clin Endocrinol Metab 19:138–151

  28. 28.

    Hu B, Wei YF, Huang C et al (2006) The strategy and relevant problems of radioiodine treatment for pediatric Grave’s disease. Journal of Medical Forum 27:67–68

  29. 29.

    Huang BH, Zhen ZW, Chen CL et al (2006) The analysis of therapeutic effects of radioiodine treatment for pediatric patients with Grave’s disease. China Tropical Medicine 6:634–635

  30. 30.

    Jiang X, Chen S (2005) The surgery treatment of pediatric hyperthroidism. Hainan Medical Journal 14:26–27

  31. 31.

    Kogut MD, Kaplan SA, Collip PJ et al (1965) Treatment of hyperthyroidism in children. N Engl J Med 272:217–221

  32. 32.

    Lazar L, Kalter-Leibovici O, Pertzelan A et al (2000) Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab 85:3678–3682

  33. 33.

    Lao DH, Xh Ye (2006) The analysis of treatments for pediatric Grave’s disease. Guangxi Medical Journal 28:1785–1786

  34. 34.

    Leu SW, Chi CS, Shu SG (2003) Outcome of antithyroid medication and radioiodine therapy in pediatric Graves’ disease. Acta Paediatr Taiwan 44:220–226

  35. 35.

    Ldfranchi S, Mandel SH (1995) Garve’ disease in the neonatal period and childhood. In: Braverman LE, Utiger RD (eds) Clinical text. Lippincott, Philidelphia, pp 1237–1246

  36. 36.

    Lippe BM, Landaw EM, Kaplan SA (1987) Hyperthyroidism in children treated with long term medical therapy: twenty-five percent remission every two years. J Clin Endocrinol Metab 64:1241–1245

  37. 37.

    Liu YF, Tan DD, Liu HF (2003) The report of surgical treatment for pediatric Grave’s disease. Chinese Medical Journal 3:43–44

  38. 38.

    Liu ZC, Liu DM, Liu DY et al (2005) The report of surgical treatment for pediatric Grave’s disease. Central Plains Medical Journal 33:56

  39. 39.

    Maenpaa J, Kuusi A (1980) Childhood hyperthyroidism. Results of treatment. Acta Paediatr Scand 69:137–142

  40. 40.

    Moll GW Jr, Patel BR (1997) Pediatric Graves’ disease: therapeutic options and experience with radioiodine at the University of Mississippi Medical Center. South Med J 90:1017–1022

  41. 41.

    Mulvihill JJ, Myers MH, Connelly RR et al (1987) Cancer in offsprings of long-term survivors of childhood and adolescent cancer. Lancet 2:813–817

  42. 42.

    Nebesio TD, Siddiqui AR, Pescovitz OH et al (2002) Time course to hypothyroidism after fixed-dose radioablation therapy of Graves’ Disease in children. J Pediatr 141:99–103

  43. 43.

    Otake M, Schull WJ, Neel JV (1990) Congenital malformations, stillbirths and early mortality among the children of atomic bomb survivors: a reanalysis. Radiat Res 122:1–11

  44. 44.

    Qin L, Wang JQ, Fenf XM et al (2004) Efficacy of (131) I therapy hyperthyroidism in adolescent. Journal of Isotopes 17:186–190

  45. 45.

    Read CH Jr, Tansey MJ, Menda Y (2004) A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab 89:4229–4233

  46. 46.

    Reid JR, Wheeler SF (2005) Hyperthyroidism: diagnosis and treatment. Am Fam Physician 72:623–630

  47. 47.

    Rivkees SA (1998) Clinical review 99: the management of Graves’ disease in children, with special emphasis on radioiodine treatment. J Clin Endocrinol Metab 83:3767–3776

  48. 48.

    Robinson A, Linden MG (1993) Three to 5% of all births result in congenital malformations. In: Clinical genetic handbook. Blackwell, Boston

  49. 49.

    Rudberg C, Johansson H, Akerstrom G et al (1996) Graves’ disease in children and adolescents. Late results of surgical treatment. Eur J Endocrinol 134:710–715

  50. 50.

    Safa AM, Schumacher OP, Rodriguez-Antunez A (1975) Long-term follow-up results in children and adolescents treated with radioactive iodine (131I) for hyperthyroidism. N Engl J Med 292:167–171

  51. 51.

    Saxena KM, Crawford JD, Talbot NB (1964) Childhood thyrotoxicosis: a long term perspective. Br Med J 2:1153–1158

  52. 52.

    Schull WJ, Otake M, Neel JV (1981) Genetic effects of atomic bombs: a re-appraisal. Science 213:1220–1227

  53. 53.

    Sheline GE, Lindsay S, McCormack KR et al (1962) Thyroid nodules occurring late after treatment of thyrotoxicosis with radioiodine. J Clin Endocrinol Metab 22:8–18

  54. 54.

    Soreide JA, van Heerden JA, Lo CY et al (1996) Surgical treatment of Graves’ disease in patients younger than 18 years. World J Surg 20:794–800

  55. 55.

    Starr P, Jaffe HL, Oettinger L Jr (1969) Later results of 131-I treatment of hyperthyroidism in 73 children and adolescents: 1967 follow up. J Nucl Med 10:586–590

  56. 56.

    Sugino K, Ito K, Mimura T et al (2004) Surgical treatment of Graves’ disease in children. Thyroid 14:447–452

  57. 57.

    Vaidya VA, Bongiovanni AM, Parks JS et al (1974) Twenty-two years' experience in the medical management of juvenile thyrotoxicosis. Pediatrics 54:565–570

  58. 58.

    Walter MA, Briel M, Christ-Crain M et al (2007) Effects of antithyroid drugs on radioiodine treatment: systematic review and meta-analysis of randomised controlled trials treatment: systematic review and meta-analysis. BMJ 334:514

  59. 59.

    Wang Q, Yang JS (2003) Clinical study of 128 adolescent hyperthyroidism after (131) I therapy. Chinese Journal of Coal Industry Medicine 6:581

  60. 60.

    Ward L, Huot C, Lambert R et al (1999) Outcome of pediatric Graves’ disease after treatment with antithyroid medication and radioiodine. Clin Invest Med 22:132–139

  61. 61.

    Wei XJ (1999) Experience with surgical treatment for juvenile hyperthyroidism. Journal of Youjiang Medical College for Nationalities 2:199–200

  62. 62.

    Wei XZ, Lin ZX (2001) Surgical treatment of juvenile hyperthyroidism. Chinese Journal of General Surgery 16:168–169

  63. 63.

    Wu WQ (2001) Effect of surgical treatment for juvenile hyperthyroidism. Guangxi Medical Journal 23:910–911

  64. 64.

    Xia LH, Zeng FZ, Chen BH et al (2003) The experience of thyroidectomy on children hypothyroidism. Modern Medicine Health 19:704

  65. 65.

    Xue JJ, Yang AM, Wang Y et al (2006) Radioiodine treatment for pediatric Grave’s disease. Journal of Chinese Physician 8:136–136

  66. 66.

    Yoshimoto Y, Neel JV, Schull WJ et al (1990) Malignant tumors during the first two decades of life in the offsprings of atomic bomb survivors. Am J Hum Genet 46:1041–1052

  67. 67.

    Zhao ZJ, Cheng TG, Yan JF (2003) The therapeutic effects of surgery for children hyperthyroidism. Chinese New Medicine 4:516–517

  68. 68.

    Zhong ZQ, Zeng FZ (1999) Effect of thyroidectomy for juvenile hyperthyroidism. Guangdong Medical Journal 20:155–156

  69. 69.

    Zhou WS (2005) Clinical study of 278 adolescent hyperthyroidism after (131) I therapy. Hainan Medical Journal 16:51

  70. 70.

    Zhou KQ (2005) The investigation of surgery for children hyperthyroidism. Henan Journal of Surgery 11:37

  71. 71.

    Zimmerman D, Lteif AN (1998) Thyrotoxicosis in children. Endocrinol Metab Clin North Am 27:109–126

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Acknowledgements

We thank the Co-ordinator of the Metabolic and Endocrine Disorders Group and Dr. Bernd Richter, Gudrun Paletta, Susanne Ebrahim, contact editor, Dr. Wu Taixiang from Evidence based center West China Hospital are of invaluable help throughout the review and we are most grateful to them for their advice and support.

Conflicts of Interest

We stated that there are no financial or other relationships that might lead to a conflict of interest.

Author information

Correspondence to Ma Chao.

Additional information

The research project has been supported by national science fund (NO, 30700185).

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Chao, M., Jiawei, X., Guoming, W. et al. Radioiodine treatment for pediatric hyperthyroid Grave’s disease. Eur J Pediatr 168, 1165–1169 (2009). https://doi.org/10.1007/s00431-009-0992-2

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Keywords

  • Radioiodine therapy
  • Thyrotoxicosis
  • Surgery
  • Graves’ disease
  • Adolescents
  • Antithyroid drug