Either Abstract

(Paediatric), #220531615228

The outcome of definitive therapy for paediatric Graves’ disease: A single centre study

Hamsa Arif Rasheed, Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia; Nurshadia Samingan, Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Meenal Mavinkurve, Department of Paediatric, Faculty of Medicine, International Medical University, Seremban; Muhammad Yazid Jalaludin, Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Azriyanti Anuar Zaini, Department of Paediatrics, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia

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Introduction

Majority of paediatric hyperthyroidism patients are diagnosed with Graves’ Disease(GD). Low remission rate and adverse events associated with antithyroid medication may warrant definitive therapy for these patients. Options of definitive therapies include total thyroidectomy(TT) or ablative therapy-radioactive iodine(RAI). Age of children, size of goitre and frequency of relapses influence the choice of definitive therapy.

Methods

Medical records of paediatric patients with GD receiving definitive therapy in University Malaya Medical Centre from 2012 to 2022 year were reviewed.

Results

Ten patients received definitive therapy. Seventy percent were female. Mean age at diagnosis is 10.7(±4.3) years old. Average duration on antithyroid medication before definitive therapy is 4.1(± 1.6) years. Median relapse rate for both groups is 2.5(1-6) times. All three patients(30%) had TT performed at post-pubertal age . Mean age at RAI is 14.9 (±4.0) years, the youngest was 8 years old. The thyroid gland weight was the decisive factor favouring TT, 92(±17.8) grams versus 22.9(±6.2) gram (RAI). Hypothyroidism occurred earlier in TT, 1.3 weeks versus 8 weeks post-RAI. Six patients became hypothyroid post-RAI, however 3 out of 7 (42%) patients relapsed. Dose of RAI was lower in relapsed patients 5.6(±3.8)mCi versus 9(±2.0)mCi, although the thyroid size was similar. Hypothyroidism was rendered in 2 patients post second RAI. No significant adverse events seen in all patients post TT.

Conclusion

Definitive therapy is safe in non-remitting paediatric GD patients. TT should be considered if the thyroid gland size is large and less likely to respond to RAI with the provision of experienced surgeon. RAI renders good outcome in difficult GD, however in younger children, small doses may not be sufficient and repeat doses maybe necessary.

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