Comparison of efficacy of ~(131)I and antithyroid drugs in the treatment of Graves′disease in children

Objective To comprehensively evaluate the treatment of Graves′ disease in children with ~(131)I and antithyroid drugs (ATD) and to quantitatively assess the advantages and disadvantages of them. Methods The authors examined the outcome of ~(131)I and ATD treatment in children with Graves′ disease at the Hospital of Dongshan District in Guangzhou during the period 1997 to 2002. Each of the 2 groups of patients consisted of 40 patients ranging in age from 8 to 14 years (mean10.7±2.2). The groups were similar in age, gender, length of disease, goiter size, and initial serum thyroid hormone levels. Thyroid status was assessed 2 year after the therapies started. The efficacy of the therapeutic methods were scored as follows: the children whose disease was cured were marked 0, and those who had improvement but were not cured were marked 1, and those who remained unchanged were marked 2. After treatment the patients who were demonstrated to have ophthalmopathy or more severe ophthalmopathy, hyperthyroid heart disease, liver function damage and leukopenia were marked 2 respectively, and those who showed temporary hypothyroidism and permanent hypothyroidism were marked 1 and 2, respectively. Those who had a relapse of the disease after being cured were marked 2. The effects of two groups and total scores were compared. Results The total score of the group treated with ~(131)I was 34; and the median score was 1; the total score of the group treated with ATD was 69, and the median score was 1.5; the difference between the two groups was statistically significant(P0.01). When these two groups were compared, the advantage of ~(131)I in the treatment of this disease was clear. The incidences of ophthalmopathy and improvement of ophthalmopathy of the two groups were not significantly different(P0.05). No significant difference was found in incidence of hypothyroidism between the two groups(P0.05). There was no significant worsening or new development of ophthalmopathy or hypothyroidism after ~(131)I and ATD treatment. The rate of relapse of hyperthyroidism among patients cured with ~(131)I was significantly lower than that among patients cured with ATD(P0.05). In the patients treated with ~(131)I the incidences of hyperthyroid heart disease, liver function damage, leukopenia and so on were significantly lower than those of patients treated with ATD (P0.05). Conclusions ~(131)I therapy was superior to the ATD in treatment of the children with Graves′ disease. Observations for more than 2 years after treatment with ~(131)I showed that there were no harmful side effects or complications. ~(131)I can be recognized as the safer, more convenient and effective treatment than ATD for Graves′ disease in children.