title: Pediatric Graves' disease: management in the post-propylthiouracil Era.
abstract: The most prevalent cause of thyrotoxicosis in children is Graves' disease (GD), and remission occurs only in a modest proportion of patients. Thus most pediatric patients with GD will need treatment with radioactive iodine (RAI; (131)I) or surgical thyroidectomy. When antithyroid drugs (ATDs) are prescribed, only methimazole (MMI) should be administered, as PTU is associated with an unacceptable risk of severe liver injury. If remission does not occur following ATD therapy, (131)I or surgery should be contemplated. When (131)I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for large glands. Considering that there will be low-level whole body radiation exposure associated with (131)I, this treatment should be avoided in young children. When surgery is performed near total or total-thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults, thus an experienced thyroid surgeon is needed when children are operated on. Most importantly, the care of children with GD can be complicated and requires physicians with expertise in the area.
authors.affiliation: Department of Pediatrics, University of Florida College of Medicine, 1600 SW Archer Road - Room R1-118, Gainesville, FL, USA.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Rivkees
keywords: Hepatotoxicity; Hyperthyroidism; Methimazole; Propylthiouracil; Radioactive iodine; Thyroid; Thyroidectomy
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