Ivannikova T E, Shiryaeva T Yu, Nagaeva E V, Sheremeta M S, Brovin D N, Bezlepkina O B
Endocrinology Research Centre.
Probl Endokrinol (Mosk). 2022 Apr 11;68(2):104-111. doi: 10.14341/probl13086.
Hyperthyreoidism due to Graves' disease is a rare disorder in pediatric practice. There is 2 treatment options in Graves' disease: medical treatment and definitive treatment, including surgery and radioactive iodine. Each method has its advantages and disadvantages. If medical therapy is ineffective the choice between radical treatment method is raised: radioactive iodine or total thyroidectomy. In this research we analyze treatment outcomes in pediatric Graves' disease patients after different radical treatment methods.
Comparative analysis of radical treatment outcomes in pediatric patients with Graves' disease.
Retrospective and prospective one-center research of 122 patients with Graves' disease after radical treatment (between 2016 and 2021)RESULTS: The mean age was 13.5±3,5 year at the moment of examination. Patients were divided into 2 groups due to the radical treatments method: 1 group (n=60) were children after surgical treatment, 2 group (n=62) - after radioactive iodine. The mean dose of medical treatment in these groups did not reliably differ (p=0,06), duration of the medical treatment was reliably longer in patients after radioactive iodine (p=0,024). Graves' orbitopathy was diagnosed in 58 patients (47,5%) and met equally often in both groups, but active stage of Graves' orbitopathy was diagnosed only in patients from the 1st group. Thyroid size was reliable bigger in patients from the 1st group (p=0,004), and thyroid gland nodes were diagnosed only in patients from 1st group (p=0,0007).
RI can be considered an effective and safe treatment for GD. The effectiveness of RI depends on the volume of the thyroid gland; according to the results of the constructed ROC curve, the risk of repeated RI is higher with a volume of more than 55 cm3. Also radioactive iodine is undesirable if there is signs of ophatalmopathy due to its possible deterioration. According to the results of the study hypoparathyroidism after surgical treatment was diagnosed in 20%, recurrent laryngeal nerve injury was diagnosed after surgical treatment in 5% of patients. In patients with identified nodular goiter according to the results of ultrasound, surgical treatment is preferable due to the impossibility of excluding thyroid cancer.
格雷夫斯病所致甲状腺功能亢进在儿科临床实践中是一种罕见疾病。格雷夫斯病有两种治疗选择：药物治疗和确定性治疗，包括手术和放射性碘治疗。每种方法都有其优缺点。如果药物治疗无效，就会面临根治性治疗方法的选择：放射性碘治疗或全甲状腺切除术。在本研究中，我们分析了不同根治性治疗方法后儿科格雷夫斯病患者的治疗结果。
对儿科格雷夫斯病患者根治性治疗结果进行对比分析。
对122例接受根治性治疗（2016年至2021年）的格雷夫斯病患者进行回顾性和前瞻性单中心研究。
检查时患者的平均年龄为13.5±3.5岁。根据根治性治疗方法将患者分为两组：第一组（n = 60）为接受手术治疗的儿童，第二组（n = 62）为接受放射性碘治疗的儿童。两组的药物治疗平均剂量无显著差异（p = 0.06），放射性碘治疗后的患者药物治疗持续时间显著更长（p = 0.024）。58例患者（47.5%）被诊断为格雷夫斯眼病，两组中出现的频率相同，但仅在第一组患者中诊断出格雷夫斯眼病的活动期。第一组患者的甲状腺大小显著更大（p = 0.004），且仅在第一组患者中诊断出甲状腺结节（p = 0.0007）。
放射性碘治疗可被认为是治疗格雷夫斯病的一种有效且安全的方法。放射性碘治疗的有效性取决于甲状腺的体积；根据构建的ROC曲线结果，甲状腺体积超过55 cm³时重复进行放射性碘治疗的风险更高。此外，如果存在眼病迹象，放射性碘治疗是不可取的，因为其可能会使病情恶化。根据研究结果，手术治疗后20%的患者被诊断为甲状旁腺功能减退，5%的患者在手术治疗后被诊断为喉返神经损伤。根据超声检查结果确诊为结节性甲状腺肿的患者，由于无法排除甲状腺癌，手术治疗更为可取。
