Chielens Laura, Nauwynck Elise, Bourgeois Sophie, Staels Willem, Vanbesien Jesse, Gies Inge, Ernst Caroline, Everaert Hendrik, De Schepper Jean
Department of Paediatrics, Vrije Universiteit Brussel, UZ Brussel, Laarbeeklaan 110, Brussels, 1090, Belgium.
Division of Paediatric Endocrinology, Vrije Universiteit Brussel, UZ Brussel, Laarbeeklaan 110, Brussels, 1090, Belgium.
Sci Rep. 2024 Dec 28;14(1):31063. doi: 10.1038/s41598-024-82052-z.
Up to 80% of children/adolescents with Graves' disease (GD) may require second-line treatment with either surgery or radioactive iodine (RAI) therapy after treatment with antithyroid drugs. These interventions aim to induce permanent hypothyroidism, but are not always successful. We aimed to evaluate the initial success rate (within the first year) of RAI treatment and its determining factors as second-line treatment in teenagers with GD. We also assessed the tolerability of RAI therapy and the onset speed of RAI-induced hypothyroidism. We conducted a retrospective chart review of children < 18 years treated with RAI (scaled fixed dose) for GD between January 2007 and December 2022 at the UZ Brussels. Fourteen teenagers treated with RAI were identified. Their ages at time of treatment ranged from 9.8 to 17.3 years, with administered I131 doses between 5.8 and 15.0mCi (median 7.9mCi). All but two patients responded within six months. Thyroxine treatment was started between 4 and 14 weeks (median 9 weeks) after RAI therapy. The time to thyroxine substitution correlated positively with age (Rho = 0.498; p = 0.099) and total I131-dose (Rho = 0.582; p = 0.047). One patient experienced transient RAI induced sialadenitis. None of the patients relapsed during a follow-up period of 1.2 to 13 years. A cure rate of 86% was observed in GD teenagers receiving a second-line RAI treatment, with no major complications. Most patients became hypothyroid within three months, underscoring the importance of early thyroid function monitoring.
高达80%的格雷夫斯病（GD）儿童/青少年在接受抗甲状腺药物治疗后可能需要手术或放射性碘（RAI）治疗作为二线治疗。这些干预措施旨在诱发永久性甲状腺功能减退，但并非总是成功。我们旨在评估RAI治疗作为GD青少年二线治疗的初始成功率（第一年）及其决定因素。我们还评估了RAI治疗的耐受性以及RAI诱发甲状腺功能减退的起效速度。我们对2007年1月至2022年12月在布鲁塞尔大学医院接受RAI（固定剂量）治疗GD的18岁以下儿童进行了回顾性病历审查。确定了14名接受RAI治疗的青少年。他们治疗时的年龄在9.8至17.3岁之间，给予的I131剂量在5.8至15.0毫居里之间（中位数为7.9毫居里）。除两名患者外，所有患者在六个月内均有反应。RAI治疗后4至14周（中位数为9周）开始甲状腺素治疗。甲状腺素替代时间与年龄呈正相关（Rho = 0.498；p = 0.099）和总I131剂量呈正相关（Rho = 0.582；p = 0.047）。一名患者经历了短暂的RAI诱发的涎腺炎。在1.2至13年的随访期内，没有患者复发。接受二线RAI治疗的GD青少年的治愈率为86%，无重大并发症。大多数患者在三个月内出现甲状腺功能减退，这突出了早期甲状腺功能监测的重要性。
