Despite low neoplasia risk, radioablation isn’t for young children
Expert guidelines state that the goal of radioablation is to induce lifelong hypothyroidism, which is managed with thyroid hormone replacement.5 The risk of neoplasia after radioablation is believed to be low with appropriate dosing. However, based on “theoretical concerns,” experts don’t recommend using radioiodine in children younger than 5 years and advise limited use in children 5 to 10 years of age.5
Medication adverse effects include rashes, transient agranulocytosis
A Cochrane review with 7 RCTs (N=620) describing withdrawal rates for patients receiving medication for Graves’ disease found that 9% to 16% of patients discontinued treatment because of adverse effects.6 Rashes were the most common adverse effect (6%-10% of patients), but as many as 3% of patients developed transient agranulocytosis. In addition, patients on medication need frequent blood tests to monitor for thyroid activity and potential toxicity.
Recommendations
The guidelines of the American Thyroid Association and the American Association of Clinical Endocrinologists state that overt Graves’ hyperthyroidism may be treated with any of the following: 131I radioablation, antithyroid medication, or thyroidectomy.3 Patient characteristics (pregnancy, mild disease, goiter compression symptoms) should help determine the appropriate option in any given case.