Antithyroid drug therapy for toxic diffuse goiter (Graves disease): Thirty years experience in children and adolescents

doi:10.1016/S0022-3476(77)80843-3

The Journal of Pediatrics

Volume 91, Issue 2, August 1977, Pages 313-320

https://doi.org/10.1016/S0022-3476(77)80843-3 Get rights and content

Since 1946 104 children and adolescents with toxic diffuse goiter have been treated. Sixty-seven were treated with a thioamide for more than 12 months. Remission occurred in 61%. Twenty-five patients had a 12-hour perchlorate discharge test to determine the least frequent dose schedule required for disease control: 68% could be controlled on a single daily dose and an additional 25% on an every 12-hour schedule. A one-hour radioiodine uptake on combined therapy and change in thyroid gland size during treatment were found to be highly correlated with the presence of a spontaneous remission. Thirty-six patients have been treated by subtotal thyroidectomy. To date 65% have developed permanent hypothyroidism. In the authors' opinion, thoamides are the treatment of choice for the majority of children and adolescents.

References (41)

BarnesHV et al.
Choosing thyroidectomy in hyperthyroidism
Surg Clin North Am
(1974)
BlizzardRM et al.
The history and present concepts in autoimmunization in thyroid disease
J Pediatr
(1960)
RootAW et al.
Treatment of juvenile thyrotoxicosis
J Pediatr
(1963)
SchlesingerS et al.
Acceleration of growth and bone maturation in childhood thyrotoxicosis
J Pediatr
(1973)
Van WykJJ et al.
Treatment of hyperthyroidism in children with Thiouracil drugs
Pediatrics
(1956)
HungW et al.
Medical therapy of thyrotoxicosis in children
Pediatrics
(1962)
ChandlerRW et al.
Incidence of thyrocytotoxic factor and other antithyroid antibodies in the mothers of cretins
N Engl J Med
(1962)
BarnesHV et al.
A simple test for selecting the thioamide schedule in thyrotoxicosis
J Clin Endocrinol Metab
(1972)
TannerJM et al.
Growth and development record, BHWV 13 and 14
(1966)
WernerSC
(1971) Ocular manifestations in the thyroid

HaylesAB et al.

Exophthalmic goiter in children: A therapeutic trial with antithyroid drugs

Mayo Clin Proc

(1965)

KogutMD et al.

Treatment of hyperthyroidism in children

N Engl J Med

(1965)

KunstadterRH et al.

Treatment of thyrotoxic children with thiourea derivatives

Am J Dis Child

(1955)

MaenpaaJ et al.

Childhood hypothyroidism

Acta Endocrinol

(1966)

NilssonLR

Thyrotoxicosis in children

Nord Med

(1961)

VaidyaVA et al.

Twenty-two years experience in the medical management of juvenile thyrotoxicosis

Pediatrics

(1974)

HargreavesAW et al.

Adolescent thyrotoxicosis

Br J Surg

(1968)

HaylesAB et al.

The treatment of hyperthyroidism (Graves' disease) in children

Mayo Clin Proc

(1967)

ReeveTS et al.

Thyroidectomy in the management of thyrotoxicosis in the adolescent

Surgery

(1969)

SanfelippoPM et al.

Indications for thyroidectomy in the pediatric patient

Am J Surg

(1971)

Cited by (87)

Thyroid Disorders in Children and Adolescents
2020, Sperling Pediatric Endocrinology: Expert Consult - Online and Print
Thyroid disease can present with overt symptoms, insidiously, or with isolated thyromegaly. Thyroid disease in children can encompass isolated biochemical abnormalities that have little or no physiologic consequence or with overt clinical symptoms. Clinically, hypothyroidism occurs more commonly than hyperthyroidism. Thyroid nodules and masses occur much less commonly than functional disorders but can portend the presence of thyroid cancer. This chapter focuses on the most common conditions that affect the thyroid gland of children and adolescents.
Hyperthyroidism, childhood and adolescence
2018, Encyclopedia of Endocrine Diseases
Hyperthyroidism can have profound effects on the growing child and adolescent, including somatic and behavioral effects. In the pediatric population, the hyperthyroid state can be present for extended periods before recognition, contributing to physical decline. A number of conditions can result in hyperthyroidism in childhood; however, Graves’ disease (GD) is the most common cause. Fortunately, the different causes of hyperthyroidism can be distinguished and specific treatments rendered. Updated guidelines for the treatment of pediatric hyperthyroidism can be found from the American Thyroid Association and from the Japanese Pediatric Thyroid Committee.
Thyroidectomy in a two-year old for graves' disease
2015, International Journal of Surgery Case Reports
Citation Excerpt :
We present the case of a two-year old male with graves’ disorder unresponsive to medical therapy who underwent near total thyroidectomy, whom we believe to be the youngest patient to undergo thyroidectomy for graves’. The estimated prevalence of graves’ in children ranges between 1 and 20 in 100,000 [1,2]. Manifestations of the disease mimic that of adults, with a few key differences.
The most common cause of hyperthyroidism in children is graves’ disease – an autoimmune disorder in which antibodies stimulate the thyrotropin receptor to signal growth thyroid gland by increasing thyroid hormone synthesis and release. It can be treated with medical therapy, radioactive iodine, or surgery.
JD was a two year old male who presented with severe diarrhea and diffuse neck enlargement. Laboratory work up was consistent with graves’ disease.
Despite maximal outpatient and inpatient treatment with methimazole, atenolol, prednisone, and SSKI, he suffered persistent thyrotoxicosis. He underwent near-total thyroidectomy without complication.
This case is notable as it may represent the youngest patient in the literature who has undergone thyroidectomy for graves’ disease.
Reliability of early iodine 123 uptake for treatment of graves disease in children
2011, Endocrine Practice
To determine the reliability of early radioiodine uptake (RAIU) in calculation of the radioiodine ablation dose for pediatric patients with Graves disease.
This retrospective review of medical records involved 22 pediatric patients with Graves disease, who had undergone early (4 to 8 hours) and late (24 to 26 hours) RAIU studies and were treated with iodine 131 (¹³¹I). Quantitative data are reported as mean ± standard error of the mean. Early and late RAIU and actual administered versus calculated ¹³¹I ablation doses were compared by using the paired t test. The correlation between early and late RAIU was assessed by curvilinear regression analysis. Significance was assessed at P < .05.
Mean early RAIU was 57.1% ± 18.2%, and mean late RAIU was 72.1% ± 14.4% (P < .05). Curvilinear regression analysis showed the following: late RAIU = 7.13 + 1.71 × (early RAIU) - 0.01 × (early RAIU)²; r² = 0.75. The mean ablation dose of ¹³¹I based on late RAIU was 9.3 ± 2.0 mCi. The calculated radioiodine dose would have been, on average, 32% higher (12.3 ± 3.8 mCi; P < .05) had early RAIU been used.
In children, early RAIU can be much lower than late RAIU. This may be misleading for ablation dose calculations. Therefore, late RAIU should be used to avoid overtreatment in children with Graves disease.
(Endocr Pract. 2011;17:541-545)
The Use of 131Iodine in the Treatment of Graves' Disease in Children
2009, Comprehensive Handbook of Iodine: Nutritional, Biochemical, Pathological and Therapeutic Aspects
Graves' disease is the most common form of hyperthyroidism in childhood. Current treatment options include antithyroid medications, surgery, and radioactive iodine. Medical therapy is generally associated with long-term remission rates of less than 25% and a small risk of serious adverse reactions that include hepatic failure and bone marrow suppression. When radioactive iodine is used in appropriate doses, there is a very high cure rate without increased risks of thyroid cancer or genetic damage. Definitive therapy in the form of surgery or radioactive iodine is necessary and unavoidable for the majority of pediatric patients with Graves' disease. Total thyroidectomy is an effective treatment of Graves' disease, with a low rate of disease recurrence. Long-term complications include recurrent laryngeal nerve paresis in 2% or more of individuals, permanent hypoparathyroidism in 1% or more, and hypertrophic and nonhypertrophic scars. Surgery is the preferred definitive treatment for a very large thyroid gland and when the individual is considered too young for ¹³¹I. When used at doses that deliver 150 Gy or more, radioactive iodine is an effective cure for Graves' disease and is associated with few acute side effects. Potential long-term adverse side effects, including thyroid cancer and genetic damage, have yet to be observed in individuals treated as children or adolescents with ¹³¹I.
The Use of <sup>131</sup>Iodine in the Treatment of Graves' Disease in Children
2009, Comprehensive Handbook of Iodine
Graves' disease is the most common form of hyperthyroidism in childhood. Current treatment options include antithyroid medications, surgery, and radioactive iodine. Medical therapy is generally associated with long-term remission rates of less than 25% and a small risk of serious adverse reactions that include hepatic failure and bone marrow suppression. When radioactive iodine is used in appropriate doses, there is a very high cure rate without increased risks of thyroid cancer or genetic damage. Definitive therapy in the form of surgery or radioactive iodine is necessary and unavoidable for the majority of pediatric patients with Graves' disease. Total thyroidectomy is an effective treatment of Graves' disease, with a low rate of disease recurrence. Long-term complications include recurrent laryngeal nerve paresis in 2% or more of individuals, permanent hypoparathyroidism in 1% or more, and hypertrophic and nonhypertrophic scars. Surgery is the preferred definitive treatment for a very large thyroid gland and when the individual is considered too young for ¹³¹I. When used at doses that deliver 150 Gy or more, radioactive iodine is an effective cure for Graves' disease and is associated with few acute side effects. Potential long-term adverse side effects, including thyroid cancer and genetic damage, have yet to be observed in individuals treated as children or adolescents with ¹³¹I.

View all citing articles on Scopus

View full text

Antithyroid drug therapy for toxic diffuse goiter (Graves disease): Thirty years experience in children and adolescents

Surg Clin North Am

J Pediatr

J Pediatr

J Pediatr

Treatment of hyperthyroidism in children with Thiouracil drugs

Pediatrics

Medical therapy of thyrotoxicosis in children

Pediatrics

Incidence of thyrocytotoxic factor and other antithyroid antibodies in the mothers of cretins

N Engl J Med

A simple test for selecting the thioamide schedule in thyrotoxicosis

J Clin Endocrinol Metab

Growth and development record, BHWV 13 and 14

(1971) Ocular manifestations in the thyroid

Exophthalmic goiter in children: A therapeutic trial with antithyroid drugs

Mayo Clin Proc

Treatment of hyperthyroidism in children

N Engl J Med

Treatment of thyrotoxic children with thiourea derivatives

Am J Dis Child

Childhood hypothyroidism

Acta Endocrinol

Thyrotoxicosis in children

Nord Med

Twenty-two years experience in the medical management of juvenile thyrotoxicosis

Pediatrics

Adolescent thyrotoxicosis

Br J Surg

The treatment of hyperthyroidism (Graves' disease) in children

Mayo Clin Proc

Thyroidectomy in the management of thyrotoxicosis in the adolescent

Surgery

Indications for thyroidectomy in the pediatric patient

Am J Surg