Time course to hypothyroidism after fixed-dose radioablation therapy of Graves' disease in children☆
Section snippets
Methods
After institutional review board approval, medical records of patients who received RAI for Graves'disease at Riley Hospital for Children in Indianapolis, Indiana, between February 1993 and June 2001 were reviewed. Inclusion criteria included the use of RAI at a fixed dose of 15 mCi (range of delivered dose, 13.8-15.6 mCi) and availability of follow-up data. All patients were diagnosed by a pediatric endocrinologist, on the basis of clinical and laboratory data. The interval from RAI treatment
Results
Of 54 patients identified as candidates for the study, 40 were included. Of the 14 patients excluded, 11 received a nonfixed dose of RAI and 2 were lost to follow-up; RAI was ineffective in 1 patient, who never became hypothyroid and eventually required thyroidectomy.
The patients included 10 boys and 30 girls. All had biochemical evidence of hyperthyroidism at diagnosis. Twenty patients had a family history of thyroid disease and 4 patients were referred to an ophthalmologist for evaluation.
Discussion
Radioiodine therapy is becoming a more popular method of treating Graves'disease in children and adolescents and has been studied previously by several investigators.13, 18, 19, 20, 21, 22, 23, 24, 25 A lower limit of age for the use of RAI in children has not been established, and medical therapy is often used initially, particularly in very young children. However, available safety data regarding the use of RAI in pediatric patients has been extremely reassuring.16 One technique of RAI
Acknowledgements
We thank Linda A. DiMeglio, MD, and Jack Fuqua, MD, for reviewing the manuscript.
References (36)
- et al.
Thyrotoxicosis in children
Endocrinol Metab Clin North Am
(1998) - et al.
Granulocytopenia, lupus-like syndrome, and other complications of propylthiouracil therapy
J Pediatr
(1970) Antithyroid drugs for the treatment of hyperthyroidism caused by Graves'disease
Endocrinol Metab Clin North Am
(1998)- et al.
Antithyroid drug therapy for toxic diffuse goiter (Graves'disease): thirty years'experience in children and adolescents
J Pediatr
(1977) - et al.
Intentional radioiodine ablation in Graves'disease
Lancet
(1975) - et al.
Treatment of hyperthyroidism with radioactive iodine
Endocrinol Metab Clin North Am
(1998) - et al.
Clinical review 99: the management of Graves'disease in children, with special emphasis on radioiodine treatment
J Clin Endocrinol Metab
(1998) The management of hyperthyroidism
N Engl J Med
(1994)- et al.
Treatment of childhood Graves'disease
Cleve Clin J Med
(1988) - et al.
Adverse effects of thyroid hormone preparations and antithyroid drugs
Drug Saf
(1996)
The antithyroid arthritis syndrome reviewed
Arthritis Rheum
Propylthiouracil hepatotoxicity: a review and case presentation
Clin Pediatr
Propylthiouracil-induced cutaneous vasculitis: case presentation and review of the literature
JAMA
Propylthiouracil and hepatitis: two cases and a review of the literature
Arch Intern Med
Management of hyperthyroidism in children and adolescents
J Clin Endocrinol Metab
Radioiodine therapy of hyperthyroidism: socioeconomic considerations
J Nucl Med
Influence of compensated radioiodine therapy on thyroid volume and incidence of hypothyroidism in Graves'disease
J Intern Med
Radioiodine treatment of juvenile Graves'disease
Exp Clin Endocrinol Diabetes
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Reprint requests: Erica A. Eugster, MD, Pediatric Endocrinology, Riley Hospital for Children, Room 5960, 702 Barnhill Dr, Indianapolis, IN 46202.