MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves' disease.

Related Articles

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves' disease.

Eur J Endocrinol. 2017 Apr 05;:

Authors: Leger J, Carel JC

Abstract
Graves' disease is an autoimmune disorder. It is the major cause of hyperthyroidism but is rare in children. Patients are initially managed with antithyroid drugs (ATD), in the form of methimazole/carbimazole. A major disadvantage of ATD treatment is the high risk of relapse, exceeding 70% of children treated for a duration of two years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in about 40 to 50% of cases after prolonged ATD treatment for several years in recent studies. Alternative ablative treatments - such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of five years, thyroidectomy, performed by pediatric surgeons with extensive experience - should be proposed in cases of non compliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers data relating to the prognosis for GD remission in children and explores the limitations of study designs and results, and the emerging proposal for management through the prolonged use of ATD drugs.

PMID: 28381452 [PubMed - as supplied by publisher]

http://ift.tt/2o4Tcmu