Pediatric Graves’ disease: management in the post-propylthiouracil Era
Open accessAbstract
The most prevalent cause of thyrotoxicosis in children is Graves' disease (GD), and remission occurs only in a modest proportion of patients. Thus most pediatric patients with GD will need treatment with radioactive iodine (RAI; (131)I) or surgical thyroidectomy. When antithyroid drugs (ATDs) are prescribed, only methimazole (MMI) should be administered, as PTU is associated with an unacceptable risk of severe liver injury. If remission does not occur following ATD therapy, (131)I or surgery should be contemplated. When (131)I is administered, dosages should be greater than 150 uCi/gm of thyroid tissue, with higher dosages needed for large glands. Considering that there will be low-level whole body radiation exposure associated with (131)I, this treatment should be avoided in young children. When surgery is performed near total or total-thyroidectomy is the recommended procedure. Complications for thyroidectomy in children are considerably higher than in adults, thus an experienced thyroid surgeon is needed when children are operated on. Most importantly, the care of children with GD can be complicated and requires physicians with expertise in the area.
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Since the recommendation to avoid PTU use in children was issued, no published cases of PTU-related liver failure are known to the authors.
“Furthermore, since the recommendation to avoid PTU use in children was issued, we are unaware of any published cases of PTU-related liver failure (327).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [327]
PTU is associated with an unacceptable risk of hepatotoxicity in children, with a risk of liver failure of 1 in 2000-4000 children taking the medication.
“PTU is associated with an unacceptable risk of hepatotoxicity in children, with a risk of liver failure of 1 in 2000-4000 children taking the medication (326,327).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [327]
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BackgroundInfluentialGraves’ ophthalmopathy: a rational approach to treatment
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“prednisone for 3 months following (131)I therapy [96].”
BackgroundPediatric Thyroid Disease: When is Surgery Necessary, and Who Should be Operating on Our Children?
Breuer, C. K., Tuggle, C. T., Solomon, D. G., & Sosa, J. A. (2012) · Journal of Clinical Research in Pediatric Endocrinology · doi:10.4274/jcrpe.817 · Cited by 72 · cited 2× · see citing works
“Considering these data, if local pediatric thyroid surgery expertise is unavailable, referral of a child with GD to a high-volume, thyroid surgery center with pediatric experience should be considered [124,125].”
BackgroundGarcía-Mayor, R. V., Páramo, C., Cano, R. L., Méndez, L. F. P., Galofré, J. C., & Andrade, A. (1992) · Journal of Endocrinological Investigation · doi:10.1007/bf03348811 · Cited by 69 · cited 1× · see citing works
“In 52 Spanish patients, following treatment for 12 or 24 months, remission rates were 46% and 54%, respectively, 2 years after cessation of therapy [40]; at 5-years, the relapse rate was 85%.”
BackgroundTajiri, J., & Noguchi, S. (2005) · Thyroid · doi:10.1089/thy.2005.15.292 · Cited by 68 · see citing works
Treatment of Hyperthyroidism in Children
Kogut, M. D., Kaplan, S. A., Collipp, P. J., Tiamsic, T., & Boyle, D. (1965) · New England Journal of Medicine · doi:10.1056/nejm196502042720501 · Cited by 67 · see citing works
Time course to hypothyroidism after fixed-dose radioablation therapy of Graves' disease in children
Nebesio, T. D., Siddiqui, A. R., Pescovitz, O. H., & Eugster, E. A. (2002) · The Journal of Pediatrics · doi:10.1067/mpd.2002.125494 · Cited by 66 · cited 3× · see citing works
“this is rarely required in children [4,62,90,91].”
BackgroundToohey, R. E., Stabin, M. G., & Watson, E. E. (2000) · RadioGraphics · doi:10.1148/radiographics.20.2.g00mc33533 · Cited by 65 · see citing works
NICHOLAS, W. C., FISCHER, R. G., STEVENSON, R. A., & BASS, J. D. (1995) · Southern Medical Journal · doi:10.1097/00007611-199509000-00018 · Cited by 64 · cited 1× · see citing works
“Although MMI is often prescribed in divided doses over the day, once a day dosing is sufficient [14] and is associated with better compliance than multiple daily doses [15].”
BackgroundHistory of the discovery and early use of radioactive iodine.
Chapman, E. M. (1983) · PubMed · Cited by 64 · see citing works
Adverse Events Associated with Methimazole Therapy of Graves' Disease in Children
Rivkees, S., Stephenson, K., & Dinauer, C. (2010) · International Journal of Pediatric Endocrinology · doi:10.1186/1687-9856-2010-176970 · Cited by 63 · see citing works
Self-citationComplications of radioiodine treatment of hyperthyroidism
Becker, D. V., & Hurley, J. R. (1971) · Seminars in Nuclear Medicine · doi:10.1016/s0001-2998(71)81039-5 · Cited by 62 · cited 2× · see citing works
“After (131)I administration, the circulating levels of thyroid hormones may increase within 4 to 10 days, as thyroid hormone is released from degenerating follicular cells [66].”
BackgroundPediatric Graves' Disease: Outcome and Treatment
Gruñeiro-Papendicck, L., Chiesa, A. E., Finkielstain, G. P., & Heinrich, J. J. (2003) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2003.16.9.1249 · Cited by 62 · cited 2× · see citing works
“After 10 years of treatment, 33% of patients treated with ATDs went into remission [45].”
BackgroundThe Ablation of Normal Thyroid Tissue with Iodine 131
Goolden, A. W. G., & Davey, J. B. (1963) · British Journal of Radiology · doi:10.1259/0007-1285-36-425-340 · Cited by 60 · cited 1× · see citing works
“It has been suggested that dosages delivering 30,000 to 40,000 cGy (rad) to the thyroid are necessary to ablate the thyroid gland [60,61]; however, doses delivering 10,000 to 20,000 cGy to the thyroid are more often used and result in partial or complete destruction of the thyroid [4,62,63].”
BackgroundThe Risk of Thyroid Cancers Following Irradiation
Dolphin, G. W. (1968) · Health Physics · doi:10.1097/00004032-196809000-00002 · Cited by 60 · cited 3× · see citing works
“09-30 uCi/gm) [98-102] and not with the higher dosages used to treat GD.”
BackgroundTreatment of childhood Graves' disease: A review with emphasis on radioiodine treatment
LEVY, W. J., SCHUMACHER, O. P., & GUPTA, M. (1988) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.55.4.373 · Cited by 60 · cited 5× · see citing works
“It is recommended that these patients receive a second dose of radioiodine [62], which can be given 6 months after initial therapy.”
BackgroundInfluentialWeetman, A. P. (2003) · Hormone Research in Paediatrics · doi:10.1159/000067837 · Cited by 59 · cited 1× · see citing works
“propylthiouracil (PTU) or methimazole (MMI), radioactive iodine (I), or surgery [4-7].”
BackgroundROSS, D. S., DANIELS, G. H., DE STEFANO, P., MALOOF, F., & RIDGWAY, E. C. (1983) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-57-2-250 · Cited by 59 · cited 2× · see citing works
“The use of SSKI or Lugol’s solution one week after (131)I will also quickly attenuate biochemical hyperthyroidism without adversely affecting the outcome of radioiodine therapy [69].”
BackgroundKadmon, P. M., Noto, R. B., Boney, C. M., Goodwin, G., & Gruppuso, P. A. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.5.7473 · Cited by 58 · cited 2× · see citing works
“There are rare reports of children with severe hyperthyroidism developing thyroid storm after (131)I [67].”
BackgroundHow Should the Dose of Iodine-131 Be Determined in the Treatment of Graves’ Hyperthyroidism?
Kalinyak, J. E., & McDougall, I. R. (2003) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2002-021801 · Cited by 57 · cited 1× · see citing works
“In adults, the two different approaches lead to similar outcomes [92,93]; however, in children, a potential advantage of calculated vs.”
BackgroundGraves' disease in children and adolescents. Late results of surgical treatment
Rudberg, C. R., Johansson, H., Åkerström, G., Tuvemo, T., & Karlsson, F. A. (1996) · European Journal of Endocrinology · doi:10.1530/eje.0.1340710 · Cited by 55 · cited 1× · see citing works
“roidectomy [95,114-116].”
LONG‐TERM RESULTS FROM GRADED LOW DOSE RADIOACTIVE IODINE THERAPY FOR THYROTOXICOSIS
Goolden, A. W. G., & Stewart, J. S. W. (1986) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1986.tb00765.x · Cited by 54 · cited 1× · see citing works
“When treated with relatively low dosages (50–75 uCi/gm), hyperthyroidism persists in 30 to 50% of adults one year after therapy [70-73].”
BackgroundHistory of the Discovery and Early Use of Radioactive Iodine
Chapman, E. M. (1983) · JAMA · doi:10.1001/jama.1983.03340150084036 · Cited by 54 · cited 2× · see citing works
“Radioactive iodine use for thyroid ablation was introduced in the 1940’s at the Massachusetts Institute of Technology and Massachusetts General Hospital [6,57].”
BackgroundLater results of 131-I treatment of hyperthyroidism in 73 children and adolescents: 1967 followup.
Starr, P., Jaffe, H. L., & Oettinger, L. (1969) · PubMed · Cited by 52 · see citing works
Incidence of hyperthyroidism in Stockholm, Sweden, 2003–2005.
Abraham‐Nordling, M., Törring, O., Lantz, M., Hallengren, B., Ohrling, H., Lundell, G. E. F., Calissendorff, J., Jörneskog, G., & Wallin, G. (2008) · European Journal of Endocrinology · doi:10.1530/eje-07-0877 · Cited by 50 · cited 1× · see citing works
“The prevalence of GD is 1 in 1,000 adults [1] and is 1 in 10,000 in the pediatric population [2].”
BackgroundAntithyroid drug regimen for treating Graves' hyperthyroidism
Abraham, P., Avenell, A., Watson, W. A., Park, C. M., & Bevan, J. S. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003420.pub3 · Cited by 50 · see citing works
Treatment of Hyperthyroidism With a Large Initial Dose of Sodium Iodide I 131
Safa, A. M. (1975) · Archives of Internal Medicine · doi:10.1001/archinte.1975.00330050047007 · Cited by 49 · see citing works
Breuer, C. K., Solomon, D., Donovan, P., Rivkees, S. A., & Udelsman, R. (2013) · International Journal of Pediatric Endocrinology · doi:10.1186/1687-9856-2013-1 · Cited by 49 · cited 2× · see citing works
“Very low complication rates for children undergoing the thyroidectomies for GD have been reported with this type of multidisciplinary model [119,124].”
BackgroundSelf-citationBuckingham, B. A. (1981) · American journal of diseases of children · doi:10.1001/archpedi.1981.02130260004003 · Cited by 48 · cited 1× · see citing works
“thyroidectomy, hyperthyroidism recurs in 10-15% of patients [95,114,115].”
BackgroundRazvi, S., Vaidya, B., Perros, P., & Pearce, S. H. S. (2006) · European Journal of Endocrinology · doi:10.1530/eje.1.02169 · Cited by 47 · cited 1× · see citing works
“dose reduction [21,22].”
Diagnosis and Management of Juvenile Hyperthyroidism in Germany: A Retrospective Multicenter Study
Dötsch, J., Siebler, T., Hauffa, B. P., Doeker, B. M., Andler, W., Bettendorf, M., Heinrich, U., Gohlke, B. C., Albers, N., Willgerodt, H., et al. (2000) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2000.13.7.879 · Cited by 46 · cited 1× · see citing works
“0 mg/kg per day [3,16-20].”
Boger, M. S., & Perrier, N. D. (2004) · Surgical Clinics of North America · doi:10.1016/j.suc.2004.01.006 · Cited by 45 · cited 1× · see citing works
“Acute complications that follow thyroidectomy include hemorrhage, hypocalcaemia, and recurrent laryngeal nerve paresis [118,120-123].”
BackgroundGraves' hyperthyroidism: how long should antithyroid drug therapy be continued to achieve remission?
Weetman, A. P. (2006) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0068 · Cited by 43 · cited 1× · see citing works
“Although prolonged ATD treatment will control biochemical hyperthyroidism, it is not clear that prolonged ATD use increases the likelihood of lasting spontaneous remission [38].”
BackgroundWilson, R., McKillop, J. H., Henderson, N., Pearson, D. W. M., & Thomson, J. A. (1986) · Clinical Endocrinology · doi:10.1111/j.1365-2265.1986.tb01676.x · Cited by 42 · see citing works
63 Years and 715 Days to the “Boxed Warning”: Unmasking of the Propylthiouracil Problem
Rivkees, S. A. (2010) · International Journal of Pediatric Endocrinology · doi:10.1155/2010/658267 · Cited by 41 · cited 1× · see citing works
“In April, 2010, the US Food and Drug Administration issued a black box regarding the use of PTU stating that PTU should not be used in children [10], except in special settings, solidifying the notion that the drug should not be used.”
BackgroundSelf-citationLow-Dose Sodium Iodide I 131 Therapy in Graves Disease
Rapoport, B. (1973) · JAMA · doi:10.1001/jama.1973.03220260030007 · Cited by 41 · see citing works
Radioactive Iodine Treatment of Graves' Disease
Crile, G. (1965) · American journal of diseases of children · doi:10.1001/archpedi.1965.02090030525002 · Cited by 40 · see citing works
Smith, J., & Brown, R. S. (2007) · Thyroid® · doi:10.1089/thy.2007.0072 · Cited by 39 · cited 1× · see citing works
“GD is due to thyroid gland stimulation by thyroid receptor antibodies [TRAbs; or thyroid stimulating immunoglobulins (TSI)] [3].”
BackgroundBouma, D. J., Kammer, H., & Greer, M. A. (1982) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem-55-6-1138 · Cited by 36 · cited 1× · see citing works
“Large glands at presentation are also associated with much lower remission rates than when gland size is normal [48-50].”
Backgroundtsch, J. D., Rascher, W., & rr, H. G. D. (2003) · Pediatric Drugs · doi:10.2165/00128072-200305020-00003 · Cited by 35 · see citing works
Gomez Cruz, M. J., Jabbar, M., Saini, N., Eng, D., Crawford, B., Vazquez, D. M., Menon, R., & Chen, M. (2012) · Pediatric Diabetes · doi:10.1111/j.1399-5448.2012.00884.x · Cited by 34 · cited 1× · see citing works
“GD can be associated with either hyper- or hypoglycemia at presentation [52,53].”
BackgroundCassio, A., Corrias, A., Gualandi, S. C., Tatò, L., Cesaretti, G., Volta, C., Weber, G., Bona, G., Cappa, M., Bal, M., et al. (2005) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2005.02415.x · Cited by 34 · cited 1× · see citing works
“0 mg/kg per day [3,16-20].”
Treatment of Pediatric Graves' Disease Is Associated with Excessive Weight Gain
van Veenendaal, N. R., & Rivkees, S. A. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-1601 · Cited by 34 · cited 1× · see citing works
“to the recommendation that dietary counseling take place when treatment is initiated [55].”
BackgroundSelf-citationSurgical management of pediatric Graves’ disease: an effective definitive treatment
Peroni, E., Angiolini, M. R., Vigone, M. C., Mari, G., Chiumello, G., Beretta, E., & Weber, G. (2012) · Pediatric Surgery International · doi:10.1007/s00383-012-3095-5 · Cited by 30 · cited 1× · see citing works
“Considering these data, if local pediatric thyroid surgery expertise is unavailable, referral of a child with GD to a high-volume, thyroid surgery center with pediatric experience should be considered [124,125].”
BackgroundRadioiodine treatment for pediatric Graves' disease
Ma, C., Kuang, A., Xie, J., & Liu, G. J. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd006294.pub2 · Cited by 30 · cited 1× · see citing works
“[18,35,36,42,43].”
LATE RESULTS OF I-131 TREATMENT OF HYPERTHYROIDISM IN SEVENTY-THREE CHILDREN AND ADOLESCENTS.
Starr, P., Jaffe, H. L., & Oettinger, L. (1964) · PubMed · Cited by 30 · see citing works
Saul Hertz, MD (1905-1950): A Pioneer in the Use of Radioactive Iodine
Hertz, B. E., & Schuller, K. E. (2010) · Endocrine Practice · doi:10.4158/ep10065.co · Cited by 26 · see citing works
Moll, G., & Patel, B. R. (1997) · Southern Medical Journal · doi:10.1097/00007611-199710000-00008 · Cited by 23 · see citing works
Thyroid Surgery in Children and Teenagers
Ching, T., Warden, M. J., & Fefferman, R. A. (1977) · Archives of Otolaryngology · doi:10.1001/archotol.1977.00780260074010 · Cited by 22 · cited 1× · see citing works
“thyroidectomy, hyperthyroidism recurs in 10-15% of patients [95,114,115].”
BackgroundEarly remission in thyrotoxicosis produced by short courses of treatment
Bing, R. F., & Rosenthal, F. D. (1982) · European Journal of Endocrinology · doi:10.1530/acta.0.1000221 · Cited by 22 · see citing works
Comparative analysis of dosimetry parameters for nuclear medicine
Toohey, R. E., & Mg, S. (1999) · OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information) · Cited by 19 · see citing works
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“0 mg/kg per day [3,16-20].”
Fujieda, M., Suzuki, K., Satō, H., Hattori, M., Wada, N., Tsuchiya, M., Okamoto, N., Murata, T., Matsudaira, M., Shimizu, M., et al. (2005) · Clinical Nephrology · doi:10.5414/cnp63437 · Cited by 18 · cited 1× · see citing works
“In the pediatric population, ANCA-mediated disease has been observed with either PTU or MMI [30,31] .”
BackgroundPoomthavorn, P., Mahachoklertwattana, P., Tapaneya-Olarn, W., Chuansumrit, A., & Chunharas, A. (2002) · PubMed · Cited by 17 · see citing works
Benavides, V. C., & Rivkees, S. A. (2010) · International Journal of Pediatric Endocrinology · doi:10.1155/2010/717303 · Cited by 14 · cited 1× · see citing works
“hypothyroidism occurs after therapy [54].”
Self-citationSlyper, A. H., Wyatt, D., & Boudreau, C. (2005) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2005.18.6.597 · Cited by 12 · see citing works
ANCA antibodies in Graves' disease
Gumá, M., Olivé, A., Juan, M., & Salinas, I. (2002) · Annals of the Rheumatic Diseases · doi:10.1136/ard.61.1.90 · Cited by 12 · see citing works
Hyperthyroidism presenting with hyperglycemia in an adolescent female
Wintergerst, K. A., Rogers, E. S., & Foster, M. B. (2011) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2011.032 · Cited by 9 · cited 1× · see citing works
“GD can be associated with either hyper- or hypoglycemia at presentation [52,53].”
BackgroundRapid control of thyrotoxicosis with combined 131I, anthithyroid drugs and KI therapy.
Refetoff, S., Demeester-Mirkine, N., Am, E., & DeGroot, L. J. (1977) · PubMed · Cited by 9 · see citing works
Incidence of hypothyroidism following small doses of 131I in the treatment of Graves' disease.
McCULLAGH, E. P., Gl, J., & Rodríguez-Antúnez, A. (1976) · PubMed · Cited by 8 · see citing works
Bm, D. (1975) · PubMed · Cited by 5 · see citing works
Flagged first, then by citations
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“PTU is associated with an unacceptable risk of hepatotoxicity in children, with a risk of liver failure of 1 in 2000– 4000 children taking the medication (326,327).”
BackgroundSelf-citation2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease
Mooij, C. F., Cheetham, T. D., Verburg, F. A., Eckstein, A., Pearce, S. H., Léger, J., & van Trotsenburg, A. S. P. (2022) · European Thyroid Journal · doi:10.1530/etj-21-0073 · Cited by 125 · see citing works
“Indications for definitive treatment include relapse after ATD treatment, serious or persistent side effects of ATD, poor compliance or obstructive symptoms from a large goiter (4, 59, 60).”
BackgroundLéger, J., Petit, I., Rodrigue, D., Lambert, A.-S., & Coutant, R. (2018) · Annales d Endocrinologie · doi:10.1016/j.ando.2018.08.001 · Cited by 70 · see citing works
Increasing Incidence of Juvenile Thyrotoxicosis in Denmark: A Nationwide Study, 1998-2012
Havgaard Kjær, R., Smedegård Andersen, M., & Hansen, D. (2015) · Hormone Research in Paediatrics · doi:10.1159/000430985 · Cited by 63 · see citing works
Pediatric Thyroidectomy: Hospital Course and Perioperative Complications
Hanba, C. J., Svider, P. F., Siegel, B., Sheyn, A. M., Shkoukani, M. A., Lin, H., & Raza, S. N. (2016) · Otolaryngology · doi:10.1177/0194599816677527 · Cited by 63 · see citing works
“proportion of patients fail these modalities, ultimately requiring surgery.(5-7) Despite numerous analyses composed of singleinstitution retrospective reviews and other patient series, there has been limited population-based inquiry evaluating pediatric thyroidectomy.”
Guidelines for the treatment of childhood-onset Graves’ disease in Japan, 2016
Minamitani, K., Sato, H., Ohye, H., Harada, S., & Arisaka, O. (2017) · Clinical Pediatric Endocrinology · doi:10.1297/cpe.26.29 · Cited by 54 · see citing works
“According to other studies, either 131I therapy or surgical treatment should be considered if remission cannot be achieved after 2 yr of antithyroid drug therapy and if a child requires at least 2–4 yr to achieve remission (73, 105, 106).”
BackgroundThe treatment of Graves' disease in children and adolescents
Lee, H. S., & Hwang, J. S. (2014) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2014.19.3.122 · Cited by 36 · see citing works
Kourime, M., McGowan, S., Altowati, M. A., Ahmed, S. F., Stewart, G. A., Williamson, S., Hunter, I., & Donaldson, M. (2017) · Archives of Disease in Childhood · doi:10.1136/archdischild-2017-313454 · Cited by 27 · see citing works
Hyperthyroidism in adolescents
Niedziela, M. (2021) · Endocrine Connections · doi:10.1530/ec-21-0191 · Cited by 20 · see citing works
Anti-thyroid drugs in pediatric Graves′ disease
John, M., Sundrarajan, R., & Gomadam, S. (2015) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.152766 · Cited by 17 · see citing works
“has proposed the following as guidance to choosing therapy in subjects with GD.[12,30] Children <5 years: MMI should be used as first‐line treatment till the patient goes into remission.”
InfluentialLong‐term health outcomes of adults with McCune‐Albright syndrome
Wong, S. C., & Zacharin, M. (2017) · Clinical Endocrinology · doi:10.1111/cen.13419 · Cited by 14 · see citing works
Kim, H., Kim, J., Huh, R., Cho, S. Y., & Jin, D. (2015) · Annals of Pediatric Endocrinology & Metabolism · doi:10.6065/apem.2015.20.2.106 · Cited by 14 · see citing works
“The mechanisms by which antithyroid agents cause an elevation of serum CK in Graves disease include (1) a direct effect of ATD on muscles, (2) the result of a concentration imbalance due to an interference in the production of thyroid hormone and (3) effects mediated by the inhibition of the production of”
BackgroundMizokami, T., Hamada, K., Maruta, T., Higashi, K., & Tajiri, J. (2020) · Endocrine Practice · doi:10.4158/ep-2019-0468 · Cited by 12 · see citing works
Treatment of Graves’ disease in children: The Portuguese experience
Marques, O., Antunes, A., & Oliveira, M. J. (2018) · Endocrinología Diabetes y Nutrición · doi:10.1016/j.endinu.2017.11.014 · Cited by 11 · see citing works
“Virtually all authors agree unanimously that 131-I is a therapeutic option for children older than 5 years old.(10,29) There is evidence that the US medical community prefers 131-I therapy as a first-line treatment.”
BackgroundKim, H., Lee, J., & Ha, J. (2018) · Clinical Case Reports · doi:10.1002/ccr3.1644 · Cited by 8 · see citing works
Delayed methimazole-induced agranulocytosis in a 6-year old patient with Graves’ disease
Puthenpura, V., Desai, K., Bauer, A. J., & Marshall, I. (2016) · International Journal of Pediatric Endocrinology · doi:10.1186/s13633-016-0034-6 · Cited by 8 · see citing works
Propylthiouracil induced ANCA-associated vasculitis in a 14-year-old girl
Schamp, V., Verfaillie, C. M., Bonroy, C., Walle, J. V., Raes, A. M., & Dehoorne, J. (2015) · Acta Clinica Belgica · doi:10.1179/2295333714y.0000000090 · Cited by 7 · see citing works
Kalra, S., Selim, S., Shrestha, D., Somasundaram, N. P., Raza, S. A., Baruah, M., Bhattacharya, S., GADVE, S. S., Bantwal, G., & Sahay, R. K. (2024) · BMC Endocrine Disorders · doi:10.1186/s12902-024-01809-9 · Cited by 7 · see citing works
Thyroid, Parathyroid, and Salivary Glands
Mettler, F. A., & Guiberteau, M. J. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-48319-3.00004-3 · Cited by 6 · see citing works
Surgical Intervention for Medically Refractory Hyperthyroidism
Knollman, P. D., Giese, A., & Bhayani, M. K. (2016) · Pediatric Annals · doi:10.3928/00904481-20160411-01 · Cited by 5 · see citing works
Schilddrüsenerkrankungen im Kindes- und Jugendalter
Krude, H. (2015) · Monatsschrift Kinderheilkunde · doi:10.1007/s00112-014-3302-7 · Cited by 5 · see citing works
Treatment of Graves’ disease in children: The Portuguese experience
Marques, O., Antunes, A., & Oliveira, M. J. (2018) · Endocrinología Diabetes y Nutrición (English ed ) · doi:10.1016/j.endien.2018.03.008 · Cited by 5 · see citing works
Long-Term Antithyroid Treatment in Pediatric and Juvenile Graves’ Disease
Delshad, H., & Takyar, M. (2020) · Intern J Endocrinol Metab · doi:10.5812/ijem.106491 · Cited by 4 · see citing works
Graves disease in infancy: a patient presentation and literature review
Beliard, K., Shyamkumar, S., Brar, P. C., & Rapaport, R. (2021) · Endocrinology Diabetes and Metabolism Case Reports · doi:10.1530/edm-20-0162 · Cited by 4 · see citing works
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“17 The remainder of the children may be publicly insured or uninsured, who were not included in the database.”
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Secular Trends in the Management of Pediatric Graves’ Disease: A 25-Year Cohort
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- Authors
- Rivkees, S. A.
- Affiliations
- University of Florida Health (US)
- Corresponding author
- Rivkees, Scott A
- ORCID
- Rivkees, Scott A
- Venue
- International Journal of Pediatric Endocrinology
- Published
- 2014-06-16
- Volume
- 2014
- Issue
- 1
- Pages
- 10-10
- ISSN
- 1687-9848 (ISSN-L)
- 1687-9856
- PMC
- PMC4118280
- OpenAlex
- W2132316708
- Cited by
- 46
- References
- 130
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 5 · 2018: 7 · 2017: 5 · 2016: 5 · 2015: 5 · 2014: 1 · 2013: 1
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- International Journal of Pediatric Endocrinology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Florida Digital Collections (University of Florida) (submittedVersion, other-oa)
- Funders
- National Institutes of Health
- U.S. Food and Drug Administration (R01FD003707)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Keywords
- pediatric Graves' disease, propylthiouracil, antithyroid drugs, methimazole, radioiodine therapy, total thyroidectomy, thyrotoxicosis, remission, liver injury, radiation exposure, thyroidectomy complications
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