ATA Guidelines Tools

17 Children and Adolescents General 47. Children with GD should be treated with MMI, RAI therapy, or thyroidectomy. RAI therapy should be avoided in very young children (<5 years). (S-M) • RAI therapy in children is acceptable if the activity is >150 µCi/g (5.55 MBq/g ) of thyroid tissue, and for children between 5 and 10 years of age if the calculated RAI administered activity is <10 mCi (<473 MBq). • Thyroidectomy should be chosen when definitive therapy is required, the child is too young for RAI, and surgery can be performed by a high-volume thyroid surgeon. 48. Beta adrenergic blockade is recommended for children experiencing symptoms of hyperthyroidism, especially those with heart rates >100 beats per minute. (S-L) ATD 49. MMI should be used in children who are treated with ATD therapy. (S-M) 50. Pediatric patients and their caretakers should be informed of side effects of ATD preferably in writing, and the necessity of stopping the medication immediately and informing their physician if they develop pruritic rash, jaundice, acolic stools or dark urine, arthralgias, abdominal pain, nausea, fatigue, fever, or pharyngitis. (S-L) 51. Prior to initiating ATD therapy, the ATA suggests that pediatric patients have, as a baseline, complete blood cell count, including white blood cell count with differential, and a liver profile including bilirubin, transaminases, and alkaline phosphatase. (W-L) 52. ATDs should be stopped immediately, and white blood counts measured in children who develop fever, arthralgias, mouth sores, pharyngitis, or malaise. (S-L) 53. In general, PTU should not be used in children. But, if used the medication should be stopped immediately and liver function and hepatocellular integrity assessed in children who experience anorexia, pruritus, rash, jaundice, light-colored stool or dark urine, joint pain, right upper quadrant pain or abdominal bloating, nausea, or malaise. (S-L) 54. Persistent minor cutaneous reactions to MMI therapy in children should be managed by concurrent antihistamine treatment or cessation of the medication and changing to therapy with RAI or surgery. In the case of a serious adverse reaction to an ATD, prescribing the other ATD is not recommended. (S-L)

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