• Graves' disease
• thyroid
• carbimazole
• thyrotoxicosis
• radioiodine

Graves’ disease remains a challenge for a young person, their family and the healthcare team. There have been no new treatment options for the newly presenting patient for over 55 years1 and the reality is that most young people will ultimately become adults who take long-term thyroid hormone replacement. This is because most young people will relapse after a course of antithyroid drug (ATD)—irrespective of whether this is of 2, 4 or 6 years’ duration. Patients who relapse and who do not want to return to ATD treatment have no option but to undergo definitive thyroid gland surgical removal or destruction by radioiodine. A small minority of patients will develop potentially dangerous early side effects of ATD and are forced in the direction of surgery or radioiodine sooner rather than later. The most notable of these side effects is agranulocytosis which resolves when the ATD is stopped. Thyroid hormone replacement is simple at one level but is not a cure, and data suggest that individuals on thyroxine treatment with normal thyroid-stimulating hormone (TSH) levels have impaired psychological well-being in comparison to controls of similar age and sex.2

The child or adolescent presenting with Graves’ disease tends to have more severe disease than an older person, is more likely to develop adverse effects when treated with ATD, is more likely to relapse when ATD …