Mooij Christiaan F, Cheetham Timothy D, Verburg Frederik A, Eckstein Anja, Pearce Simon H, Léger Juliane, van Trotsenburg A S Paul
Department of Pediatric Endocrinology, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, UK.
Eur Thyroid J. 2022 Jan 1;11(1):e210073. doi: 10.1530/ETJ-21-0073.
Hyperthyroidism caused by Graves' disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults - antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The 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 (3 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.
格雷夫斯病（GD）引起的甲状腺功能亢进症在儿童中是一种相对罕见的疾病。治疗选择与成人相同——抗甲状腺药物（ATD）、放射性碘（RAI）或甲状腺手术，但每种方式的风险和益处各不相同。欧洲甲状腺协会指南为伴有或不伴有眼眶病的儿童GD管理提供了新的建议。临床医生应警惕GD在儿童中可能表现为行为改变或学业成绩下降。建议对所有儿童甲状腺功能亢进症患者检测血清促甲状腺激素受体抗体。管理建议包括一线使用延长疗程的甲巯咪唑/卡比马唑ATD治疗（3年或更长时间），优先选择剂量滴定而非阻断加替代ATD，并避免使用丙硫氧嘧啶。在需要确定性治疗时，建议行全甲状腺切除术或RAI，目标是通过个性化的RAI活度实现甲状腺完全消融。我们建议避免对10岁以下儿童使用RAI，但对于甲状腺肿大的患者更倾向于手术治疗。所有病例都应由儿科内分泌学家参与处理。
