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Iodine-131 therapy of hyperthyroidism in pediatric patients
J D Clark1, M J Gelfand, A H Elgazzar
1Department of Radiology, Children's Hospital, University of Cincinnati, OH 45229-3039.
Insights
Radioactive iodine (131I) therapy is effective for treating hyperthyroidism in children, including cases resistant to antithyroid drugs. Potential side effects like vomiting and enuresis require careful management.
Area of Science:
- Pediatric Endocrinology
- Nuclear Medicine
- Internal Medicine
Background:
- Hyperthyroidism in children often requires long-term management.
- Antithyroid drugs like propylthiouracil and methimazole have limitations including noncompliance and side effects.
- Radioactive iodine therapy offers an alternative treatment modality.
Purpose of the Study:
- To assess the effectiveness of radioactive iodine (131I) in treating pediatric hyperthyroidism.
- To identify and evaluate short-term side effects associated with 131I therapy in children.
Main Methods:
- Retrospective analysis of 35 pediatric patients treated with 131I for hyperthyroidism.
- Evaluation of treatment outcomes, including need for retreatment and development of hypothyroidism.
- Documentation of clinical management issues and adverse events.
Main Results:
- 131I therapy was successful in 86% of patients with a single dose; 14% required retreatment.
- Common reasons for switching to 131I included drug noncompliance or treatment failure.
- Short-term side effects observed were vomiting and enuresis in some patients, with rare instances of radiation thyroiditis and nodularity.
Conclusions:
- Radioactive iodine (131I) is an effective treatment for pediatric hyperthyroidism, suitable for both initial therapy and cases refractory to medical management.
- Vomiting and enuresis are potential clinical management challenges that necessitate specific precautions in pediatric patients.
- The study confirms the utility of 131I while highlighting the importance of managing associated side effects in this age group.
Unlabelled:
The purpose of this retrospective study was to evaluate the utility of 131I as therapy for hyperthyroidism in children and to evaluate its short-term side effects.
Methods:
The results of 131I therapy of hyperthyroidism were evaluated in a group of 35 pediatric patients.
Results:
In 29 patients propylthiouracil or methimazole therapy was abandoned due to noncompliance (13), relapse or failure to control hyperthyroidism (13), vasculitis (1), neutropenia (1) or a lupus-like syndrome (1). Average treatment activity was 7.7 +/- 2.9 (s.d.) mCi, corresponding to 0.16 +/- 0.03 mCi/g. Thirty patients (86%) received a single radioiodine treatment and five (14%) were retreated. In patients who became hypothyroid after a single dose, hypothyroidism was noted within 100 days of treatment. Clinical management problems included vomiting in four patients and enuresis in four patients. Mild radiation thyroiditis occurred in one patient and nodularity was noted after therapy in two patients.
Conclusion:
Iodine-131 is effective for both initial treatment of hyperthyroidism and the treatment of medical treatment failures in pediatric patients. Awareness of vomiting and enuresis as potential management problems is crucial when using 131I in this age group. Therefore, special treatment precautions may be required.