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Hyperthyroidism: advantages and disadvantages of medical therapy

2004; Elsevier BV; Volume: 84; Issue: 3 Linguagem: Inglês

10.1016/j.suc.2004.01.007

1558-3171

Elizabeth N. Pearce, Lewis E. Braverman,

Thyroid Cancer Diagnosis and Treatment

Graves' disease is the most common form of hyperthyroidism in childhood. Current treatment options include antithyroid medications, surgery, and radioactive iodine. Medical therapy is generally associated with long-term remission rates of less than 25% and a small risk of serious adverse reactions that include hepatic failure and bone marrow suppression. When radioactive iodine is used in appropriate doses, there is a very high cure rate without increased risks of thyroid cancer or genetic damage. Definitive therapy in the form of surgery or radioactive iodine is necessary and unavoidable for the majority of pediatric patients with Graves' disease. Total thyroidectomy is an effective treatment of Graves' disease, with a low rate of disease recurrence. Long-term complications include recurrent laryngeal nerve paresis in 2% or more of individuals, permanent hypoparathyroidism in 1% or more, and hypertrophic and nonhypertrophic scars. Surgery is the preferred definitive treatment for a very large thyroid gland and when the individual is considered too young for 131I. When used at doses that deliver 150 Gy or more, radioactive iodine is an effective cure for Graves' disease and is associated with few acute side effects. Potential long-term adverse side effects, including thyroid cancer and genetic damage, have yet to be observed in individuals treated as children or adolescents with 131I.