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A 14-year-old female attends the paediatric Emergency Department with noticeable palpitations, tremor and debilitating headache. On observations, she was found to have a heart rate of 112 bpm and a blood pressure of 149/56 mm Hg. She had presented 3 years prior and diagnosed with juvenile Graves’ hyperthyroidism and started on methimazole to achieve euthyroidism. Two months ago, she began a gradual reduction of her antithyroid medication. Her most recent thyroid function tests show a low Thyroid Stimulating Hormone (TSH) and a significantly raised free T3 and T4. You suspect recurrent Graves’ disease but are unsure what definitive treatment to achieve remission should be given. Her parents are reluctant to restart her antithyroid medication. They have read about radioiodine online and ask for your opinion on which treatment has the best evidence of achieving remission in the long term.
In children with Graves’ hyperthyroidism (population), should radioiodine or antithyroid drugs (intervention) be used to achieve remission (outcome)?
MEDLINE (2000-present via PubMed), Embase (2000-present via Ovid) and the Cochrane Library were used for the search. Search terms were (Paediatric OR Juvenile OR Child) AND (Grave* OR Hyperthyroid*) AND (Radioiod* OR Thyroid* OR Anti*). Embase revealed 206 hits, Medline had 304 hits and Cochrane had one hit. A further search was conducted to include Graves’ disease in adults to ensure none excluded contained data on juvenile Graves’ disease. Inclusion criteria: English language, publications in the last 20 years (when modern biochemical criteria were established), articles looking at thyroid function in children under 18 years …
Contributors JT developed the manuscript concept. JT and KS completed the literature review and critical appraisal.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.