Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

There are three methods in treatment of Graves’ disease in children and adolescents – antithyroid drugs, surgery and radioiodine therapy (RIT). However, treatment protocol of children and adolescents doesn’t exist. In the present case series study we have evaluated the effectiveness and safety of RIT in children and adolescents. We have observed totally 25 patients in age 11–17 years old (mean 14.8 years) with Graves’ disease. Ten patients were treated with RIT in Endocrinology Research Centre (Moscow) in 2016 year with activities 550–920 MBq. Follow-up period varied 6–11 months in this subgroup. The second subgroup (15 patients) was treated in radiology department in Nijniy Tagil rural hospital (Ural region) in the period 2005–2012 years. Follow-up period varied 3.5–11.5 years (mean 8.5 years). RIT was executed in all patients without any complications, direct or long-term. In two patients having endocrine ophtalmopathy in non-active phase it was no any signs of worsening in result of RIT. In 17 (68%) of 25 patients the hypothyroidism occurred through 6 months. In one case – euthyroidism. In remain 7 observations the hyperthyroidism recurred. Patient subgroups didn’t differ in mean age, gender ratio, thyroid size and autoantibodies to TSH receptor levels, but were differed in treatment 131I activities (subset from ERC – 550–920 MBq; subset from Nijniy Tagil – 168–400 MBq). However the treatment efficacy did not differ significantly (p = 0.99): 68% and 73%, accordingly. In conclusion, RIT of Graves’ disease in a safe and effective method of treatment for hyperthyroidism in children and adolescents. It’s necessary to prolong study in numerous patients cohort, longer-lasting follow-up period as well as to improve RIT efficiency.

1. Gruneiro-Papendieck L, Chiesa A, Finkielstain G, Heinrich JJ. Pediatric Graves’ disease: outcome and treatment. J Pediatr Endocrinol Metab. 2003;16(9):1249-1255.

2. Zimmerman D, Lteif AN. Thyrotoxicosis in children. Endocrinol Metab Clin North Am. 1998;27(1):109-126.

3. Kaguelidou F, Alberti C, Castanet M, et al. Predictors of autoimmune hyperthyroidism relapse in children after discontinuation of antithyroid drug treatment. J Clin Endocrinol Metab. 2008;93(10):3817-3826. doi: 10.1210/jc.2008-0842.

4. Lazar L, Kalter-Leibovici O, Pertzelan A, et al. Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab. 2000;85(10):3678-3682. doi: 10.1210/jcem.85.10.6922.

5. Vaidya B, Wright A, Shuttleworth J, et al. Block & replace regime versus titration regime of antithyroid drugs for the treatment of Graves’ disease: a retrospective observational study. Clin Endocrinol (Oxf). 2014;81(4):610-613. doi: 10.1111/cen.12478.

6. Abraham P, Avenell A, Park CM, et al. A systematic review of drug therapy for Graves’ hyperthyroidism. Eur J Endocrinol. 2005; 153(4):489-498. doi: 10.1530/eje.1.01993.

7. Laurberg P, Krejbjerg A, Andersen SL. Relapse following antithyroid drug therapy for Graves’ hyperthyroidism. Curr Opin Endocrinol Diabetes Obes. 2014;21(5):415-421. doi: 10.1097/MED.0000000000000088.

8. Jevalikar G, Solis J, Zacharin M. Long-term outcomes of pediatric Graves’ disease. J Pediatr Endocrinol Metab. 2014;27(11-12): 1131-1136. doi: 10.1515/jpem-2013-0342.

9. Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics. 2003; 111(4 Pt 1):745-749.

10. Read CH, Jr., Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves’ patients. J Clin Endocrinol Metab. 2004;89(9):4229-4233. doi: 10.1210/jc.2003-031223.

11. Sheline GE, Lindsay S, McСormack KR, Galante M. Thyroid nodules occurring late after treatment of thyrotoxicosis with radioiodine. J Clin Endocrinol Metab. 1962;22:8-18. doi: 10.1210/jcem-22-1-8.

12. Namwongprom S, Unachak K, Dejkhamron P, et al. Radioactive iodine for thyrotoxicosis in childhood and adolescence: treatment and outcomes. J Clin Res Pediatr Endocrinol. 2013;5(2):95-97. doi: 10.4274/Jcrpe.951.

13. Rivkees SA. Controversies in the management of Graves’ disease in children. J Endocrinol Invest. 2016;39(11):1247-1257. doi: 10.1007/s40618-016-0477-x.

14. Turner N, Driver I, Salotti JA, et al. Increasing use of radioiodine in young people with thyrotoxicosis in Great Britain. Eur J Endocrinol. 2012;167(5):715-718. doi: 10.1530/EJE-12-0542.

15. Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves’ disease is radioiodine. J Clin Endocrinol Metab. 2007;92(3):797-800. doi: 10.1210/jc.2006-1239.

16. Rivkees SA. Graves’ disease therapy in children: truth and inevitable consequences. J Pediatr Endocrinol Metab. 2007;20(9):953-955.

17. Krassas GE. Treatment of juvenile Graves’ disease and its ophthalmic complication: the ‘European way’. Eur J Endocrinol. 2004;150(4):407-414.

18. Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.