Thyrotoxicosis Guidelines Stress Patient-Centered Graves Approach

Recommendation 50: Children with GD should be treated with methimazole, ¹³¹I therapy, or thyroidectomy. ¹³¹I therapy should be avoided in very young children [younger than 5 years]. ¹³¹I therapy in patients between 5 and 10 years of age is acceptable if the calculated ¹³¹I administered activity is [less than] 10 mCi. ¹³¹I therapy in patients older than 10 years of age is acceptable if the activity is [greater than] 150 mcCi/g of thyroid tissue. Thyroidectomy should be chosen when definitive therapy is required, the child is too young for ¹³¹I, and surgery can be performed by a high-volume thyroid surgeon.

Recommendation 71: We suggest that patients taking methimazole who decide to become pregnant obtain pregnancy testing at the earliest suggestion of pregnancy and be switched to propylthiouracil as soon as possible in the first trimester and changed back to methimazole at the beginning of the second trimester. Similarly, we suggest that patients started on propylthiouracil during the first trimester be switched to methimazole at the beginning of the second trimester

Recommendation 86: Patients with Graves’ hyperthyroidism and active moderate to severe or sight-threatening ophthalmopathy should be treated with either methimazole or surgery.