Background: Graves’s disease (GD) is the most common cause of hyperthyroidism. Maximal 30% of pediatric GD patients achieve remission with antithyroid drugs. The majority of patients therefore require definitive treatment. Both thyroidectomy and radioactive iodine (RAI) are often used as definitive treatment for GD. However, data on efficacy and short- and long-term side effects of RAI treatment for pediatric GD are relatively scarce. Methods: A systematic review of the literature (PubMed and Embase) was performed to identify studies reporting the efficacy or short- and long-term side effects of RAI treatment in pediatric GD. Results: Twenty-three studies evaluating 1,283 children and adolescents treated with RAI for GD were included. The treatment goal of RAI treatment changed over time, from trying to achieve euthyroidism in the past to aiming at complete thyroid destruction and subsequent hypothyroidism in the last 3 decades. The reported efficacy of a first RAI treatment when aiming at hypothyroidism ranged from 42.8 to 97.5%, depending on the activity administered. The efficacy seems to increase with higher RAI activities. When aiming at hypothyroidism, both short- and long-term side effects of treatment are very rare. Long-term side effects were mainly seen in patients in whom treatment aimed at achieving euthyroidism. Conclusion: RAI is a safe definitive treatment option for pediatric GD when aiming at complete thyroid destruction. When aiming at hypothyroidism, the efficacy of treatment seems to increase with a higher RAI activity. Prospective studies are needed to determine the optimal RAI dosing regimen in pediatric GD.
Eur Thyroid J

中文翻译：

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放射性碘治疗小儿 Graves 病的疗效和短期和长期副作用：系统评价

背景：格雷夫斯病 (GD) 是甲状腺功能亢进的最常见原因。最多 30% 的儿科 GD 患者使用抗甲状腺药物获得缓解。因此，大多数患者需要明确的治疗。甲状腺切除术和放射性碘（RAI）通常被用作GD的明确治疗。然而，关于 RAI 治疗儿童 GD 的疗效和短期和长期副作用的数据相对稀少。方法：对文献（PubMed 和 Embase）进行系统回顾，以确定报告 RAI 治疗对儿科 GD 的疗效或短期和长期副作用的研究。结果：纳入了 23 项评估 1,283 名接受 RAI 治疗 GD 的儿童和青少年的研究。RAI 治疗的治疗目标随着时间的推移而发生变化，从过去试图实现甲状腺功能正常到最近 3 年以甲状腺完全破坏和随后的甲状腺功能减退为目标。报告的针对甲状腺功能减退症的第一次 RAI 治疗的疗效范围为 42.8% 至 97.5%，具体取决于所施用的活动。功效似乎随着更高的 RAI 活动而增加。针对甲状腺功能减退症，治疗的短期和长期副作用都非常罕见。长期副作用主要见于治疗旨在实现甲状腺功能正常的患者。结论：当旨在完全破坏甲状腺时，RAI 是儿童 GD 的一种安全的确定性治疗选择。针对甲状腺功能减退症，RAI 活性越高，治疗效果似乎越强。需要前瞻性研究来确定儿童 GD 的最佳 RAI 给药方案。
欧洲甲状腺杂志