Radioactive iodine therapy for pediatric Graves’ disease: a single-center experience over a 10-year period
-
Paul B. Kaplowitz
,
Jiji Jiang
Abstract
Introduction
Only about 30% of pediatric patients with Graves’ hyperthyroidism achieve remission with medical therapy, and therefore radioactive iodine (RAI) therapy is often used as a definitive treatment. Although the goal of RAI is permanent hypothyroidism, this is not consistently achieved. We conducted a chart review to determine the factors associated with the success of RAI. We also tried to determine optimal follow-up post RAI and if there was an optimal L-thyroxine dose that would normalize the hypothyroid state quickly.
Methods
This is a retrospective chart review of Graves’ patients who underwent RAI between 2008 and 2017. We included age, sex, time from diagnosis, thyroid gland size, total dose of I-131 and dose in μCi/g of thyroid tissue. Patients were grouped based on outcome and analyzed using univariate and multivariate logistic regression. Follow-up thyroid levels post RAI and after starting l-thyroxine were analyzed.
Results
There were 78 ablations including six repeat ablations. Seventy-three percent became hypothyroid, 23% remained overtly or subclinically hyperthyroid, and 4% were euthyroid. Smaller thyroid size (36.5 vs. 47.4 g; p = 0.037) and higher dose of I-131 (242 vs. 212 μCi/g thyroid tissue; p = 0.013) were associated with a higher likelihood of hypothyroidism. Most patients remained hyperthyroid at 1 month post RAI, but by 3 months the majority became hypothyroid. There was no clear L-thyroxine dose that normalized hypothyroidism quickly.
Conclusions
An I-131 dose close to 250 μCi/g of thyroid tissue has a higher likelihood of achieving hypothyroidism. Testing at 2–3 months after RAI is most helpful to confirm response to RAI.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Ethical statement: In accordance with the Helsinki Declaration, the participants were informed about the exact procedure of the study and they took part voluntarily. All participants gave their approval.
References
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Articles in the same Issue
- Frontmatter
- Original Articles
- Vitamin D status in Israeli pediatric type 1 diabetes patients: the AWeSoMe Study Group experience and literature review
- Metabolic features and changes in glucose-induced serum glucagon-like peptide-1 levels in children with hypothalamic obesity
- Assessment of intima-media thickness of the carotid artery and intraluminal diameter of the brachial artery as cardiovascular risk markers in Brazilian adolescents with overweight or obesity
- The role of LCPUFA-ω3 on the obesity-associated hyperandrogenemia of pubertal girls: secondary analysis of a randomized clinical trial
- Genetic variants of the phenylalanine hydroxylase gene in patients with phenylketonuria in the northeast of Iran
- Oral health status of children with phenylketonuria
- Birth weight related blood concentrations of the neurotransmission amino acids glutamine plus glutamate, phenylalanine and tyrosine in full-term breastfed infants perinatally
- Hyperthyrotropinemia is common in preterm infants who are born small for gestational age
- Radioactive iodine therapy for pediatric Graves’ disease: a single-center experience over a 10-year period
- The decision-making levels of urine tetrasaccharide for the diagnosis of Pompe disease in the Turkish population
- A questionnaire study on sleep disturbances associated with Prader-Willi syndrome
- Body size measurements, digit ratio (2D:4D) and oestrogen and progesterone receptors’ expressions in juvenile gigantomastia
- The effect of celiac disease and gluten-free diet on pubertal development: a two-center study
- Observational study of disorders of sex development in Yaounde, Cameroon
- Letter to the Editor
- Reforming the male Tanner genital scale
- Short Communication
- The association between vitamin D levels and precocious puberty: a meta-analysis
- Case Reports
- Partial trisomy 9p and 14q microduplication in a patient with growth retardation: a case report and review of the literature
- Two different missense mutations of PEX genes in two similar patients with severe Zellweger syndrome: an argument on the genotype-phenotype correlation
- Patient report
- Marked phenotypic variable expression among brothers with duplication of Xq27.1 involving the SOX3 gene
- Case Report
- Does the risk of arterial hypertension increase in the course of triptorelin treatment?
