Surgical treatment of thyrotoxicosis in children and adolescents

Abstract

Forty-one children and adolescents had thyroidectomies for Grave's disease during an 8 yr period. Twenty patients became euthyroid within a short period after treatment with antithyroid drugs and had operations with minimal disruption of their lives. Antithyroid drugs were administered to 20 patients for a longer period of time as a primary form of treatment for Grave's disease. Complications resulting from drug toxicity, poor cooperation by patients, and persistent goiters were indications for thyroidectomies in this group. Permanent remissions, after prolonged antithyroid drug therapy, are rare in children. Because the treatment is associated with significant morbidity, this form of therapy is unacceptable in most cases. Iodine-131 was given to 30 children or adolescents for Grave's disease during the same time period. Iodine-131 is primarily indicated for patients who are resistant or allergic to antithyroid drugs, who have serious systemic diseases, or who have had previous thyroid operations. Hypothyroidism is an inevitable result of effective 131I treatment of Grave's disease in children. Serious consequences from 131I therapy were not observed during the short period of follow-up. Subtotal thyroidectomy continues to be the preferred primary treatment for most patients with Grave's disease in childhood. Total thyroidectomy may be indicated for patients in the first decade of life. Hypothyroidism, which is easily managed in this age group, is the price paid for the prevention of recurrent Grave's disease. Early detection and treatment of hypothyroidism can be achieved only by a careful follow-up of all patients treated by less than total thyroidectomy for Grave's disease.