iThyroid.com

GRAVES IN CHILDREN

The following email written by Julia from Atomic Women describes some important points in dealing with Graves' in children.

Subj: [hyperthyroidism] Re: radioactive iodine treatment
Date: 12/18/00 8:44:39 PM Pacific Standard Time
From: j_alicia39@hotmail.com (Julia )
Reply-to: hyperthyroidism@egroups.com
To: hyperthyroidism@egroups.com

--- In hyperthyroidism@egroups.com, ranchos@s... wrote:
> Hi everybody: I'm following the RAI string closely, since my child (2 years old) is in a situation where the Drs are saying RAI or surgery is the only way. Apparently, the TSD treatment can't be continued with him without damage to the bone marrow. Anyone know about this?> 


Hola otra vez Jose,

If you have already seen chapter 15 of deGroot (thyroidmanager) text, 
you'll have found which treatments are used for Graves' in children. 

DeGroot quotes that PTU or MMI are the initial choice.
PTU in more severe cases due to its property of inhibiting conversion 
of T4 into T3. MMI, longer high life, fewer tablets to take. 
And the addition of beta blockers when there is cardio-vascular 
activity.

He also makes an indication, as an alternative to decreasing the 
dosage of thyroid-blockers, which is not very much used in USA for 
adults (though it is rather used in Europe), and is the 
supplementation with thyroxine (T3) to avoid hypothyroidism (some 
people call this Block and Replace Therapy).

He says: "The optimum duration of therapy is unknown. Approximately 
50% of children will go into long term remission within 4 years, with 
a continuing remission rate of 25% every 2 years for up to 6 years of 
treatment"

The statistics he gives for side effects of drugs, are higher than in 
adults, 5% to 14% of children, however they add "Most reactions are 
mild and do not contraindicate continued use. In more severe cases, 
switching to the other thioamide frequently is effective".

Now, here you have another opinion. This is from Dr Ridha Arem, who 
on page 252 of "The Thyroid Solution" says:

"One of the adverse effects of antithyroid medications that often 
worries patients is agranulocytosis, a reaction in the bone marrow, 
which suddenly stops manufacturing white blood cells. This 
frightening complication, which occurs more frequently in the first 
three months of treatment, should not cause you undue anxiety because 
it is quite rare. One study showed that this complication occurs in 
only 3 out of 10.000 people treated with medication each year. 
Although physicians usually do not monitor your blood cell count, it 
is safer if this is done each time you have your thyroid tested while 
being treated"

On page 254, regarding radioiodine treatment, he says:

"One recent study, for instance, concluded that the incidence of 
stomach cancer may increase years after the treatment, particularly 
in younger people. Because these concerns are not quite settled yet , 
it is perhaps safer to treat children and adolescents with 
medications first and consider radioiodine treatment for young people 
as a last resort".

On page 254, he adds: "I tend to recommend surgery for children and 
adolescents who have not responded to the medication or could not 
tolerate it. Surgery often cures the condition and prevents 
fluctuation of thyroid levels and its detrimental effect on mood and 
behavior".

One thing that stroke me when I read today deGroot's text therapies 
for children (I have to confess that I was not in the details of 
infant hyperthyroidism) was the amount of radioiodine they give to 
children:

"Although a dose of 50 to 200 mCi of 131I/estimated gram of thyroid 
tissue has been used, the higher dosage is recommended, particularly 
in younger children, in order to completely ablate the thyroid gland 
and thereby reduce the risk of future neoplasia. 

The size of the thyroid gland is estimated, based on the assumption 
that the normal gland is 0.5-1.0 gms/year of age, maximum 15-20gms."

This doses are the ones used for patients with thyroid cancer. 

I received 8 millicuries of I-131, for a normal size gland, let's say 
20/25 grams weight (it was unnoticeable in my neck). So this dose for 
a small 2 y.o. whose glands weight can reach 2 grams, 3 grams … 
really made me chill.

So, José, you have several things to mull down:

In case your son is not having real problems, and Doctor's words only 
reflect his concern about antithyroid use, you may choose going along 
with meds while you introduce John's recommendations in your son's 
diet, checking his blood count regularly.

Things to ponder are, as well, that thyroid glands in children are 
pretty much sensitive to radiation than the adult's ones. There is 
also an increased rate for getting cancer, and cellular damage which 
can manifest in the descendants. Conventional doctors sometimes say 
that "it has not been observed", when in fact it has not been 
researched. Data to rely upon, is given by Chernobyl disaster, and 
the effects of fallout in Bellorusian children, which have gone far 
beyond all prior estimations. 

Yet another thought: After I-131 or surgery you boy will be 
hypothyroid, and depending on lifelong thyroxine replacement therapy. 
But this is not is not always fine tuned. There are quite many people 
who can talk on this one. And a properly and millimetrically fixed 
dose is very important for children, as thyroid hormones are 
essential for the growth and maturation of many tissues, brain and 
skeleton included. 

Now, in another post, I'm sending you a recent abstract reporting how 
Graves' in children in treated in Europe. You'll note a great 
difference compared with the information above as 99% of European 
doctors consider antithyroid drugs the way to go for treating 
hyperthyroidism in children.

I really wish you and your wife strength and good luck. 

Julia