Pediatric Graves' disease: outcome and treatment

Abstract

Graves' disease treatment in children and adolescents includes antithyroid drugs (ATD), 131I (RI) or subtotal thyroidectomy (CX), all of which present beneficial effects and disadvantages.

Objective: To review our experience in the management of pediatric patients with Graves' disease considering the therapeutic strategies used.

Patients and methods: Clinical and biochemical data of 116 children (23 boys) aged 11.2 +/- 3.7 years at diagnosis were reviewed. Outcome and remission were evaluated and persistency at 10 years calculated with Kaplan Meier analysis.

Results: Initially 113/116 patients received ATD, two RI and one CX. After 10 years of follow up, 38 remitted with ATD, 23 were persistently hyperthyroid with ATD, 38 received RI, one underwent CX, and 13 were lost to follow up. The cumulative proportion with persistent hyperthyroidism at 10 years was 31%.

Conclusions: ATD, although the first choice of treatment, was long-lasting and achieved a low remission rate at 10 years of follow up. Conversely, RI was shown to be a safe, low cost, efficient and definitive alternative for Graves' disease treatment in children and adolescents.