title: Should radioiodine be the first-line treatment for paediatric Graves' disease?
abstract: BACKGROUND
  Debate exists regarding the optimal treatment strategy for paediatric Graves' disease with radioiodine (RAI), and surgery, usually reserved for failure of medical therapy. We present our own experience to introduce a review of the published literature focussing on the predictors of remission after antithyroid drug (ATD) therapy from diagnosis, and discuss whether RAI should be considered as a first-line therapy.
  
  
  METHODS
  A retrospective analysis of all diagnosed cases of paediatric Graves' disease presenting to a large District General Hospital.
  
  
  RESULTS
  Thirteen patients were diagnosed with Graves' disease between February 2004 and May 2013. The median age at diagnosis was 13.7 years (range 7.2-17.1 years) with a female:male ratio of 11:2. Some nine patients completed a 2-year course of carbimazole out of which 8 relapsed after a mean duration of 0.82 years (range 0.08-1.42 years); the ninth currently remains in remission. Of the eight patients who relapsed, three have undergone RAI treatment. Two patients failed to tolerate carbimazole treatment, one of whom received RAI treatment because surgery was contraindicated and one patient with severe autism proceeded to RAI treatment due to poor compliance and persistent hyperthyroidism.
  
  
  METHODS
  Prognostic factors at presentation predicting a low likelihood of remission following ATD treatment include younger age, non-Caucasian ethnicity, and severe clinical and/or biochemical markers of hyperthyroidism. Psycho-social factors including compliance also influence management decisions.
  
  
  CONCLUSIONS
  In specifically selected patients presenting with paediatric Graves' disease, the benefits and risks of radioactive iodine as a potential first-line therapy should be communicated allowing families to make informed decisions.
authors.forename: James D
authors.initials: JD
authors.lastname: West
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Cheetham
authors.forename: Carole
authors.initials: C
authors.lastname: Dane
authors.forename: Anuja
authors.initials: A
authors.lastname: Natarajan
mesh_terms: D000293:Adolescent; D013956:Antithyroid Agents / Q000627:therapeutic use; D002231:Carbimazole / Q000627:therapeutic use; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D002231:Carbimazole