Endocrine Abstracts

Introduction: Definitive treatment for pediatric Grave’s disease includes radioiodine ablation (RAI) or thyroidectomy. The aim of this systematic review and meta-analysis was to compare the cure and relapse rates of RAI vs surgery as definitive therapy in children with Grave’s disease.

Methods: A comprehensive search on Cochrane library, EMBASE, PUBMED and ClinicalTrials.gov for English articles published on definitive treatment of Grave’s disease in children since 1985 to 2022 was performed. The data was extracted and analyzed for treatment outcomes, adverse outcomes, risk of bias (ROB) and evidence summated using the GRADE instrument.

Results: Twenty-eight (26 retrospective and 2 prospective) studies with a total of 2571 children (F2057:514M) and a mean age of 13.15 years, with a mean follow up of 8 years were included. Studies were at risk of low to moderate risk of bias. Analysis suggested better cure rates at 12 months for thyroidectomy (95%) compared to RAI 81% (OR 0.9; 95% CI 0.8–1.00 ); (pheterogeneity = 0.01; I2 = 39%). Recurrence rates was higher in RAI group (11.4% vs 8.7%; OR 1.22; 95% CI: 0.26-5.77); (pheterogeneity = 0.002; I2 = 73%). In subgroup analysis of patients from 16 studies who underwent surgery, total thyroidectomy was more effective than subtotal thyroidectomy in preventing recurrent hyperthyroidism in 0.7 VS 7.8%; (P 0.001; moderate quality evidence). Hypothyroidism rates after RAI and surgery were similar (~ 70%). There were no significant adverse outcomes reported such as secondary malignancy or quality of life after RAI. Following total thyroidectomy, adverse effects seen were permanent hypoparathyroidism at 0.4% and temporary recurrent laryngeal nerve palsy at 5.4%.

Conclusion: Thyroidectomy is more effective than radioiodine therapy in effecting cure in Graves’ disease in children following failed remission. However, access to thyroidectomy may not be universally available and RAI is an option in these children.