title: Surgical management of pediatric Graves' disease: an effective definitive treatment.
abstract: OBJECTIVE
  The optimal treatment for pediatric Graves' disease (GD) is controversial. Antithyroid drugs are often used initially, but they are associated with a high failure rate. Therefore alternative therapies have become important. In the present study, we analyze our institution's experience regarding the safety and efficacy of thyroid surgery among pediatric patients with GD.
  
  
  METHODS
  This is a retrospective chart review of 27 pediatric patients (age ≤ 18 years) with GD who underwent thyroid surgery between 1991 and 2009 at a single academic Institution. We recorded preoperative, intraoperative, and short-term postoperative data.
  
  
  RESULTS
  All 27 patients were initially treated with thionamides. The high rate of hyperthyroidism relapse after discontinuation of medical treatment, age < 5 years, adverse reaction to medical therapy, severe ophthalmopathy, and patient preference justified the final decision to proceed with surgery as definitive therapy. All patients underwent total thyroidectomy. We had no mortality; surgical complications were rare: 4 (14.8 %) cases of transient hypocalcemia, 1 (3.7 %) of permanent hypocalcemia, 3 (11.1 %) of transient RLN neuropraxia, and 2 (7 %) of keloid scar. No bleeding, permanent RLN palsy or relapse hyperthyroidism were reported.
  
  
  CONCLUSIONS
  Surgical therapy for pediatric GD performed by experienced thyroid surgeons is a safe, definitive and cost-effective treatment.
authors.affiliation: Department of Pediatric Endocrinology, San Raffaele Hospital, Vita-Salute San Raffaele University, Via Olgettina, 60, Milan, Italy. ele.peroni86@gmail.com
authors.forename: Elena
authors.initials: E
authors.lastname: Peroni
authors.forename: Maria Rachele
authors.initials: MR
authors.lastname: Angiolini
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Vigone
authors.forename: Gilberto
authors.initials: G
authors.lastname: Mari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Chiumello
authors.forename: Edoardo
authors.initials: E
authors.lastname: Beretta
authors.forename: Giovanna
authors.initials: G
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006111:Graves Disease / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome