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Experts: Weigh risks, benefits of antithyroid therapies in children with Graves’ disease
Physicians should weight the adverse effects of antithyroid therapies, which are especially increased in children, against the benefits while choosing a therapy for children with Graves’ disease, according to Mathew John, MD.
“Radioactive iodine therapy would be a good choice, especially if children have not achieved remission within 2 years of antithyroid therapies,” John, of the Providence Endocrine & Diabetes Specialty Centre in India, told Endocrine Today.
Graves’ disease is the most common cause of hyperthyroidism in children and most children and adolescents are treated with antithyroid therapies as the initial modality, according to background information provided in the study abstract.
For the review, John and colleagues compiled data from previously published research on pediatric Graves’ disease.
They found studies include various regimens, remission rates, duration of therapy for adequate remission, follow-up and adverse effects of antithyroid therapies.
Regarding adverse effects, when compared with adults, children appear to experience more minor and major adverse effects, therefore limiting initial and long-term treatment with antithyroid therapies.
In particular, treatment with Tapazole (methimazole, Pfizer), carbimazole and propylthiouracil has been restricted in children due to liver injury including hepatocellular failure and the need for liver transplantation. This combination therapy has been previously used either as titration regimens or as block and replacement regimens, according to the researchers.
Remission rates after antithyroid therapy were highest among children with lower thyroid hormone levels, who underwent prolonged duration of treatment, had lower thyroid-stimulating hormone receptor antibody levels, smaller goiter and were older. The overall rate for persistent remission with antithyroid therapies following discontinuation was 30%, according to the researchers.
Among older children with Graves’ disease, the researchers found that radioactive iodine therapy has gained more acceptance in the limitations of antithyroid therapies.
“For individual patients, the risk-benefits ratio of antithyroid therapies should be weighed against benefits of radioactive iodine therapy and patient preferences,” the researchers wrote. - by Jennifer Southall
Disclosure: The researchers report no relevant financial disclosures.