title: Pediatric Graves' disease: decisions regarding therapy.
abstract: OBJECTIVE
  Graves' disease is the most common cause of hyperthyroidism in the pediatric population. It occurs more often in adolescence and in girls; however, prepubertal children tend to have more severe disease, require longer medical therapy, and have a lower rate of remission as compared with pubertal children. The choice of which of the three therapeutic options to use (medical therapy, radioactive iodine ablation, or surgery) must be individualized. This update will focus on the current diagnostic and treatment modalities available, as well as address the controversy that exists with regards to permanent therapy.
  
  
  RESULTS
  The diagnosis of Graves' disease is often made clinically. With the development of second-generation and third-generation thyroid-stimulating hormone receptor antibody assays, it can be more reliably confirmed. An improved understanding of the underlying autoimmune process and genetics is underway; however, remission rates in children and adolescents remain low. Because of its ease of administration and long-term follow-up, there is a trend towards permanent therapy with radioactive iodine ablation when remission cannot be achieved with medical therapy.
  
  
  CONCLUSIONS
  New genes and susceptibility loci have been identified with the hope of better understanding the refractory nature of Graves' disease. Despite the low rates of remission, permanent therapy with radioactive iodine remains a good option.
authors.affiliation: aDivision of Endocrinology, Department of Medicine bDivision of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Erin R
authors.initials: ER
authors.lastname: Okawa
authors.forename: Frederick D
authors.initials: FD
authors.lastname: Grant
authors.forename: Jessica R
authors.initials: JR
authors.lastname: Smith
mesh_terms: D000293:Adolescent; D013956:Antithyroid Agents / Q000627:therapeutic use*; D002648:Child; D003657:Decision Making; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000628:therapy*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000628:therapy*; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D057285:Precision Medicine; D018570:Risk Assessment; D013965:Thyroidectomy / Q000379:methods*; D013972:Thyrotropin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D013972:Thyrotropin