Controversies in the pharmacological treatment of Graves' disease in children. Issue 11 (2nd November 2018)

• Record Type: Journal Article
• Authors: De Luca, Filippo; Valenzise, Mariella
• Is Part Of: Expert review of clinical pharmacology. Volume 11:Issue 11(2018)
• Page Start: 1113
• Page End: 1121
• Publication Date: 2018-11-02
• Subjects: Autoimmune thyroid disease -- fetal and neonatal hyperthyroidism -- Graves' disease -- Hashitoxicosis -- methimazole treatment -- pediatric age -- radioiodine therapy -- thyroidectomy; Clinical pharmacology -- Periodicals; 615.105
• DOI: 10.1080/17512433.2018.1546576
• Languages: English
• ISSNs: 1751-2433

Abstract

ABSTRACT: Introduction : Graves' disease (GD) is a disorder, in which auto-immunity against the thyroid- stimulating hormone (TSH) receptor is the pivotal pathogenetic element. This disease may have different clinical manifestations, the most common being thyrotoxicosis. Treatment of this condition differs according to its etiology, but there is currently no evidence-based therapeutic strategy which is universally adopted in all countries. Areas covered : a systematic review of the updates on the management of pediatric GD was performed using the Pubmed data base until March 2018. Systematic reviews with or without meta-analysis were analyzed using the following terms: Antithyroid drugs, Childhood, Hyperthyroidism, Radioactive iodine, Thyroidectomy. Expert commentary : As the best way to manage children with GD remains a matter of debate among pediatric endocrinologists, and there is currently no evidence-based therapeutic strategy which is universally adopted, we confirm that the original and prolonged treatment with anti-thyroid drugs (ATDs) remains the mainstay of treatment for juvenile hyperthyroidism. Alternative treatments include radioiodine (RAI) therapy or surgery (total thyroidectomy). We recommend individualizing the therapeutic approach, without prejudices toward radical therapies that become necessary in case of relapse, adverse effects or poor compliance to ATDs. The optimal approach depends on patient or family preference, and specific patient clinical features.