Commentary on "Long-term outcomes of Graves’ disease in children and adolescents receiving antithyroid drugs"

Background/aims Treatments for Graves' disease (GD) in children and adolescents include oral antithyroid drugs (ATDs), near total thyroidectomy, and radioactive iodine (RAI). ATDs remain the preferred choice in this age group, but because persistent remission occurs in 30% of cases, RAI is becoming a common option for definitive therapy. Methods We performed a review of 65 medical records of GD patients under age 19 years who were followed between 1985 and 2005. Results The prevalence of GD was higher in females (3:1) and during puberty (for both genders). If no remission was detected during ATD treatment, RAI was indicated when the following criteria were present: non-compliance, relapse, or side effects that were related to ATDs, large goiter, and long-term use of ATDs. The majority of patients developed hypothyroidism within 6 months after RAI. A progressive higher dose regimen was implemented in the last 10 years of the study period. A second RAI dose was necessary in eight cases. During the follow-up period, three pregnancies occurred. One patient with a thyroid nodule and benign cytology was detected. Conclusions RAI therapy is effective and safe in the treatment of GD in children and adolescents.

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Long-Term Outcomes of Pediatric Graves Disease Patients Treated with Anti-Thyroid Drugs: Experience from a Taiwan Medical Center

10.1101/618942 ◽

2019 ◽

Author(s):

Ya-Ting Chiang ◽

Wei-Hsin Ting ◽

Chi-Yu Huang ◽

Shih-Kang Huang ◽

Chon-In Chan ◽

...

Keyword(s):

Family History ◽

Children And Adolescents ◽

Thyroid Disease ◽

Remission Rate ◽

Medical Center ◽

Graves Disease ◽

Long Term Outcomes ◽

History Of

AbstractGraves disease (GD) is the most common cause of thyrotoxicosis in children and adolescents, accounting for 15% of all thyroid diseases during childhood. Anti-thyroid drugs (ATD) are recommended as the first-line treatment in children and adolescents. However, the remission rate is lower in children than in adults, and the optimal treatment duration and favorite factors associated with remission remain unknown. We aimed to investigate long-term outcomes of pediatric GD patients receiving ATD. We retrospectively reviewed medical charts of 300 pediatric GD subjects, who were initially treated with ATD and followed up for more than one year, from 1985 to 2017 at MacKay Children’s Hospital. The 300 patients comprised 257 (85.7%) females and 43 (14.3%) males, median age at diagnosis was 11.6 (range 2.7-17.8) years, and median follow-up period was 4.7 (range 1.1-23.9) years. Overall, 122 patients achieved the criteria for discontinuing ATD treatment, seventy-nine (39.9%) patients achieved remission, with a median follow-up period of 5.3 (range 1.5-20.1) years. Patients in the remission group were more likely to be aged < 5 years (remission vs. relapse vs. ongoing ATD; 11.4 vs. 0 vs. 2.6%, P=0.02), less likely to have a family history of thyroid disease (24.1 vs. 42.1 vs. 52.6 %, P=0.001), and had lower TRAb levels (42.8 vs. 53.6 vs. 65.1 %, P=0.02).ConclusionLong-term ATD remains an effective treatment option for GD in children and adolescents. Pediatric GD patients aged < 5 years, having no family history of thyroid disease and having lower TRAb levels were more likely to achieve remission.

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Long‐term outcomes for children and adolescents with Kaposi sarcoma

HIV Medicine ◽

10.1111/hiv.13191 ◽

2021 ◽

Author(s):

Allison Silverstein ◽

William Kamiyango ◽

Jimmy Villiera ◽

Erin C. Peckham‐Gregory ◽

Casey L. McAtee ◽

...

Keyword(s):

Children And Adolescents ◽

Kaposi Sarcoma ◽

Long Term Outcomes ◽

Outcomes For Children

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LONG-TERM OUTCOMES OF RADIOIODINE THERAPY FOR JUVENILE GRAVES DISEASE WITH EMPHASIS ON SUBSEQUENTLY DETECTED THYROID NODULES: A SINGLE INSTITUTION EXPERIENCE FROM JAPAN

Endocrine Practice ◽

10.4158/ep-2019-0468 ◽

2020 ◽

Vol 26 (7) ◽

pp. 729-737 ◽

Cited By ~ 1

Author(s):

Tetsuya Mizokami ◽

Katsuhiko Hamada ◽

Tetsushi Maruta ◽

Kiichiro Higashi ◽

Junichi Tajiri

Keyword(s):

Thyroid Gland ◽

Thyroid Nodules ◽

Radioiodine Therapy ◽

Antithyroid Drug ◽

Overt Hypothyroidism ◽

Graves Disease ◽

Outpatient Basis ◽

Long Term Outcomes

Objective: To investigate the long-term outcomes of radioiodine therapy (RIT) for juvenile Graves disease (GD) and the ultrasonographic changes of the thyroid gland. Methods: All of 117 juvenile patients (25 males and 92 females, aged 10 to 18 [median 16] years) who had undergone RIT for GD at our clinic between 1999 and 2018 were retrospectively reviewed. Each RIT session was delivered on an outpatient basis. The maximum 131I dose per treatment was 13.0 mCi, and the total 131I dose per patient was 3.6 to 29.8 mCi (median, 13.0 mCi). 131I administration was performed once in 89 patients, twice in 26, and three times in 2 patients. Ultrasonography of the thyroid gland was regularly performed after RIT. The duration of follow-up after the initial RIT ranged from 4 to 226 (median 95) months. Results: At the latest follow-up more than 12 months after RIT (n = 111), the patients' thyroid functions were overt hypothyroidism (91%), subclinical hypothyroidism (2%), normal (5%), or subclinical hyperthyroidism (2%). New thyroid nodules were detected in 9 patients, 4 to 17 years after initial RIT. Patients with newly detected thyroid nodules underwent RIT with lower doses of 131I and had larger residual thyroid volumes than those without nodules. None of the patients were diagnosed with thyroid cancer or other malignancies during the follow-up period. Conclusion: Over a median follow-up period of 95 months (range, 4 to 226 months), RIT was found to be effective and safe in juvenile GD. However, cumulative evidence from further studies is required to confirm the long-term safety of RIT for juvenile GD. Abbreviations: ATD = antithyroid drug; GD = Graves disease; KI = potassium iodide; LT4 = levothyroxine; MMI = methimazole; PTU = propylthiouracil; RAIU = radio-active iodine uptake; RIT = radioiodine therapy; 99mTc = technetium-99m; TSH = thyrotropin

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Long-term monitoring of Graves’ disease in children and adolescents: a single-center experience

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1804-177 ◽

2019 ◽

Vol 49 (2) ◽

pp. 464-471

Author(s):

Selma TUNÇ

Keyword(s):

Children And Adolescents ◽

Graves Disease ◽

Single Center ◽

Single Center Experience ◽

Long Term Monitoring ◽

Term Monitoring

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The Effects of Hypertension on Cognitive Function in Children and Adolescents

International Journal of Pediatrics ◽

10.1155/2012/891094 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 7

Author(s):

Stephen D. Cha ◽

Hiren P. Patel ◽

David S. Hains ◽

John D. Mahan

Keyword(s):

Children And Adolescents ◽

Pediatric Population ◽

Organ Damage ◽

Future Research ◽

Cognitive Effects ◽

Long Term Outcomes ◽

Future Studies ◽

End Organ Damage ◽

Anxiety Depression

Hypertension (HTN) is found in about 3-4% of the pediatric population with long-term risks of end organ damage if untreated or poorly controlled. Although children with HTN are being more frequently screened for end organ damage (i.e., LVH), the cognitive effects of HTN and methods to screen for cognitive dysfunction have not been extensively explored. In recent years, there have been a small number of studies that have provided important insights that can guide future research in this area. These studies show that HTN can be associated with headaches, restlessness, sleep disturbance, anxiety, depression, decreased attention, and also poor executive functioning. By increasing the utilization of cognitive tests in hypertensive children and adolescents, important cognitive defects secondary to HTN may be detected. More research is needed in the area, and the results of future studies could have far reaching implications for long-term outcomes in hypertensive children and adolescents.

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Outcomes analysis of radioactive iodine and total thyroidectomy for pediatric Graves’ disease

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2015-0333 ◽

2016 ◽

Vol 29 (3) ◽

Cited By ~ 10

Author(s):

Reuven Zev Cohen ◽

Eric I. Felner ◽

Kurt F. Heiss ◽

J. Bradley Wyly ◽

Andrew B. Muir

Keyword(s):

Children And Adolescents ◽

Total Thyroidectomy ◽

Relapse Rate ◽

Radioactive Iodine ◽

High Volume ◽

Graves Disease ◽

Complication Rates ◽

Case Volume ◽

Definitive Therapy

AbstractThe majority of pediatric patients with Graves’ disease will ultimately require definitive therapy in the form of radioactive iodine (RAI) ablation or thyroidectomy. There are few studies that directly compare the efficacy and complication rates between RAI and thyroidectomy. We compared the relapse rate as well as the acute and long-term complications of RAI and total thyroidectomy among children and adolescents with Graves’ disease treated at our center.Medical records from 81 children and adolescents with a diagnosis of Graves’ disease who received definitive therapy over a 12-year period were reviewed.Fifty one patients received RAI and 30 patients underwent thyroidectomy. The relapse rate was not significantly different between RAI and thyroidectomy (12.1% vs. 0.0%, p=0.28). There were no acute or long-term complications in the RAI group, but there were eight cases of hypoparathyroidism (two transient and six permanent) in the thyroidectomy group. None of the patients developed a recurrent laryngeal nerve injury.RAI is a safe and effective option for treatment of children and adolescents with Graves’ disease. In light of the rate of permanent hypoparathyroidism seen at our center with thyroidectomy and previously published long-term safety of RAI, we recommend RAI as the first line treatment for children and adolescents with Graves’ disease. For those centers performing thyroidectomies, we recommend that each center select 1–2 high-volume pediatric surgeons to perform all thyroid procedures, allowing individuals to increases case volume and potentially decrease long-term complications of thyroidectomy.

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