2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

in European Thyroid Journal
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  • 1 C Mooij, Emma Childrens' Hospital UMC, Amsterdam, 1105 AZ, Netherlands
  • | 2 T Cheetham, Department of Pediatric Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
  • | 3 F Verburg, Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands
  • | 4 A Eckstein, Essen, Germany
  • | 5 S Pearce, Endocrinology, Newcastle University, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland
  • | 6 J Leger, Pediatric Endocrinology, APHP-Université de Paris, Paris, France
  • | 7 A Trotsenburg, University of Amsterdam, Amsterdam, Netherlands

Correspondence: Christiaan Mooij, Email: c.mooij@amsterdamumc.nl
Open access

Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults - anti-thyroid drugs (ATD), radio-active iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. This European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (three years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.


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