The Management of Graves’ Disease in Children, with Special Emphasis on Radioiodine Treatment

Extract

The most common cause of thyrotoxicosis in children and adults is Graves’ disease, an autoimmune disorder characterized by diffuse goiter, hyperthyroidism and ophthalmopathy (1–4). Thyrotoxicosis can be also seen in children with T₄ ingestion and acute or subacute thyroiditis, and occasionally in patients with chronic lymphocytic thyroiditis (4). However, the hyperthyroid state is transient in these conditions, whereas thyrotoxicosis is persistent in Graves’ disease (4). Toxic adenomas and multinodular goiters may also cause long-standing hyperthyroidism in children (4). These conditions, however, are uncommon causes of thyrotoxicosis in children and may be distinguished from Graves’ disease by palpation of the thyroid gland and/or diagnostic imaging (4).

In Graves’ disease, the spontaneous development of antibodies (TSAbs) that mimic TSH action leads to the excessive production and release of thyroid hormone, resulting in thyrotoxicosis. Untreated, thyrotoxicosis can have pernicious physical and behavioral effects on growing children and adolescents (1–4) and is commonly associated with weight loss, polyuria and polydipsia, palpitations, impaired skeletal mineralization, behavioral disturbances, and poor academic performance (1–4). Because Graves’ disease is a protracted disorder that only rarely spontaneously resolves (1–4), treatment of hyperthyroidism is essential for the well-being of the child and adolescent.