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An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine

Yale Pediatric Thyroid Center, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut 06520

Address all correspondence and requests for reprints to: Scott A. Rivkees, M.D., Yale Pediatrics, P.O. Box 208081, 464 Congress Avenue, New Haven, Connecticut 06520. E-mail: Scott.Rivkees{at}Yale.edu.

Context: Antithyroid medications, surgery, and radioactive iodine have been used for more than five decades for the treatment of hyperthyroidism due to Graves’ disease in children, adolescents, and adults. Despite the widespread use of these different approaches, controversy still exists relative to the merits of each treatment, especially regarding the use of radioactive iodine.

Objective: The objective of the study was to address the risk and benefits of ¹³¹I therapy, as compared with other treatment approaches.

Position: Long-term, spontaneous remission of Graves’ disease occurs in less than 30% of children. Thus, the majority of children with Graves’ disease will need definitive, curative therapy. There is little evidence that use of antithyroid medications beyond 1 or 2 yr increases the likelihood of spontaneous, long-term remission. Although the use of antithyroid medications is standard practice, the use of antithyroid medications involves definite risks. When used at sufficient doses, radioactive iodine is an effective cure for Graves’ disease and is associated with few acute side effects. Potential long-term adverse side effects, including thyroid cancer and genetic damage, have yet to be observed in individuals treated as children or adolescents with ¹³¹I.

Conclusion: Properly administered, radioactive iodine remains an ideal form of treatment for Graves’ disease in the pediatric population. Because of the increased risk of thyroid cancer associated with low-dose thyroid irradiation in children, larger, rather than smaller, doses of ¹³¹I should be given.

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