Graves' disease in childhood.

Area of Science:

• Pediatric Endocrinology
• Nuclear Medicine
• Thyroidology

Background:

• Graves' disease (GD) is the predominant cause of thyrotoxicosis in children, accounting for 10-15% of pediatric thyroid conditions.
• Clinical manifestations in children generally mirror those in adults.
• Conventional treatments include antithyroid drugs (ATD), thyroidectomy, and radioiodine (131I).

Purpose of the Study:

• To review the therapeutic options for pediatric thyrotoxicosis caused by Graves' disease.
• To evaluate the safety and efficacy of radioiodine (131I) therapy in children.
• To discuss the evolving trends in treatment selection for childhood Graves' disease.

Main Methods:

• Review of existing literature on the treatment of pediatric Graves' disease.
• Analysis of long-term follow-up data for radioiodine treatment in children and adolescents.
• Comparison of antithyroid drugs, thyroidectomy, and radioiodine therapy.

Main Results:

• Antithyroid drugs (ATD) are frequently used first-line despite side effects and high relapse rates.
• Radioiodine (131I) therapy is increasingly advocated for children over five, showing high remission rates.
• Both thyroidectomy and radioiodine treatment commonly result in permanent hypothyroidism requiring lifelong therapy.

Conclusions:

• Radioiodine therapy is considered safe and effective for older children and adolescents with Graves' disease based on current long-term data.
• While no increased risk of thyroid malignancy has been observed, further large-scale studies are needed.
• Radioiodine's low risk, cost, and practicality favor its use, though acceptance varies geographically.