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Influence of prior carbimazole on the outcome of radioiodine therapy in pediatric and adolescent Graves’ disease

Objective of the studyTherapeutic options for pediatric Graves’ disease (PGD) include antithyroid drug therapy (ATD) as the first line and radioiodine (I-131) therapy as the second line of treatment. To date, controversies persist regarding the true effect of prior ATD in the outcome of I-131 therapy in PGD. This study evaluated the effect of prior carbimazole treatment on the outcome of I-131 therapy in PGD. MethodsThis is a retrospective study covering the years 1995–2012, with a median follow-up of 75 months. Records of 114 children (84 girls and 30 boys, age range: 5–20 years, mean 24-h radioiodine uptake, 58%) who had clinically and biochemically proven Graves’ disease irrespective of prior ATD therapy were included. All patients were treated with fixed doses of 5 mCi (185 MBq) I-131 for Graves’ disease; 74 had undergone prior carbimazole treatment (group 1) and 40 were drug naive (group 2). The endpoint of follow-up was stable euthyroid or hypothyroid in patients. The effect of prior carbimazole treatment on the outcome of I-131 therapy in PGD patients was evaluated. The success of radioiodine therapy was defined as the cure of hyperthyroidism. Variables were analyzed to identify the potential predictive factors for euthyroidism/hypothyroidism after treatment. ResultsThe cure rate was 70% in group 1 and 83% in group 2 with a single dose of radioiodine (P=0.299). The success rate achieved at the end of 1-year follow-up in group 1 and group 2 was 81 and 87%, respectively (P=0.401). No independent predictor was associated with success or failure of treatment. At the median follow-up of 75 months (range: 12–216 months), 76% of patients were hypothyroid on replacement doses of levothyroxine and 24% still continued to be euthyroid. ConclusionPrior carbimazole treatment does not alter the outcome of radioiodine therapy in PGD.