18
Graves' Disease
55. If MMI is chosen as the first-line treatment for GD in children, it
may be tapered in those children requiring low doses after 1–2
years to determine if a spontaneous remission has occurred, or
it may be continued until the child and caretakers are ready to
consider definitive therapy, if needed. (S-M)
RAI (For Cancer Risk See Table 15, Appendix)
56. Pediatric patients with GD who are not in remission following at
least 1–2 years of MMI therapy should be considered for treatment
with RAI or thyroidectomy. Alternatively, if children are tolerating
ATD therapy, ATDs may be used for extended periods. (S-L)
• This approach may be especially useful for the child not considered to be a
candidate for either surgery or RAI. Individuals on prolonged ATD therapy
(>2 years) should be reevaluated every 6-12 months and when transitioning to
adulthood.
57. The ATA suggests that children with GD having total T
4
levels of
>20 ug/dL (260 nmol/L) or free T
4
>5 ng/dL (60 pmol/L) who are
to receive RAI therapy be pretreated with MMI and β-adrenergic
blockade until total T
4
and/or free T
4
normalize before proceeding
with RAI treatment. (W-L)
58. If RAI therapy is chosen as treatment for GD in children, sufficient
RAI should be administered in a single dose to render the patient
hypothyroid. (S-M)
Surgery
59. Children with GD undergoing thyroidectomy should be rendered
euthyroid with the use of MMI. A potassium iodide containing
preparation should be given in the immediate preoperative period. (S-L)
60. If surgery is chosen as therapy for GD in children, total or near-total
thyroidectomy should be performed. (S-M)
61. Thyroidectomy in children should be performed by high-volume
thyroid surgeons. (S-M)
