endosergЭндокринная хирургияEndocrine Surgery2306-35132310-3965Типография «Печатных дел Мастер»10.14341/serg201646-12endoserg-8322Research ArticleОбзоры литературыReview of literatureРадиойодтерапия тиротоксикоза у детей. Показания, эффективность и безопасность. Обзор литературы.Radioiodine therapy of thyrotoxicosis in children and adolescents. Indications, efficacy and safety. Literature reviewhttps://orcid.org/0000-0002-7721-634XРумянцевПавел ОлеговичRumiantsevPavel Olegovich

доктор медицинских наук, заместитель директора

MD, PhD

rumyantsev.pavel@endocrincentr.ruКияевАлексей ВасильевичKiyaevAlexey Vasil'evich

Доцент кафедры, д.м.н.

MD, PhD

thyroend@mail.ruhttps://orcid.org/0000-0003-3785-0335ШереметаМарина ВикторовнаSehemetaMarina Sergeevna

к.м.н.

MD, PhD

marina888@yandex.ruhttps://orcid.org/0000-0002-4743-4661ЧикулаеваОльга АлександровнаChikulaevaOlga Alexandrovna

к.м.н.

MD, PhD

chikulaeva.olga@gmail.com<p>ФГБУ "Эндокринологический научный центр" Минздрава России</p>Россия<p>Endocrinology Research Centre</p>Russian Federation<p>ГБУЗ Свердловской области &ldquo;Детская областная больница №1&rdquo;</p>Россия<p>Pediatric regional hospital No1</p>Russian Federation201624122016104612Copyright &#x00A9; Румянцев П.О., Кияев А.В., Шеремета М.В., Чикулаева О.А., 20162016Румянцев П.О., Кияев А.В., Шеремета М.В., Чикулаева О.А.Rumiantsev P.O., Kiyaev A.V., Sehemeta M.S., Chikulaeva O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.surg-endojournals.ru/jour/article/view/8322

Болезнь Грейвса (БГ) – основная причина тиреотоксикоза у детей. В современной клинической практике применяется три метода лечения БГ: тиреостатики, радиоактивный йод и операция. Все эти методы лечения применяются давно, и в мире накоплен огромный опыт применения каждого из методов лечения. Лечение начинают практически всегда с тиреостатиков, непереносимость или неэффективность которых становится показанием к выбору альтернативных методов лечения. Для осознанного выбора метода лечения необходимо понимать его потенциальные параметры эффективности и безопасности, а также влияющие на них факторы. Цель обзора – критический анализ эффективности и безопасности радиойодтерапии в лечении тиреотоксикоза у детей и подростков в сравнении с аналогичными показателями других методов лечения, а также показания и противопоказания к данному виду лечения в современной клинической практике эндокринологов, радиологов и эндокринных хирургов. Выбор тактики лечения БГ у ребенка на каждом этапе осуществляется согласованно с ним и его родителями/опекунами путем информирования лечащим врачом об объективных преимуществах и недостатках методов лечения на основе имеющейся доказательной базы. Также приведены основные рекомендации эффективной и безопасной терапии радиоактивным йодом БГ у детей и подростков.

Graves’ disease (GD) is the most prevalent cause of thyrotoxicosis in children. Comprehensive clinical practice contains three methods of choice in the treatment of GD: antithyroid drugs, radioactive iodine and surgery. All these treatment methods are using for a long time resulting in great amount clinical experience accumulated. Virtually in all cases the treatment starting with antithyroid drugs and then inefficiency or complications leads to choose the alternative treatment method. The conscious choice of treatment method is based on potential efficacy and safety parameters understanding as well as affecting factors. The purpose of this review – a critical evidence-based analysis of efficacy/safety of radioiodine treatment of GD in children and adolescents compared with other treatment methods as well as the place and indications for this type of treatment in contemporary clinical practice of endocrinologists, radiologists and endocrine surgeons. The choice of treatment strategy at any step is adjusting with patient and his parents/guardians by informing with objective merits and demerits of methods upon existing evidence basis. Main recommendations of effective and safe therapy of GD with radioiodine in children and adolescents are also disclosed.

: радиойодтерапиядетиподросткиболезнь Грейвсатиреотоксикозradioiodine therapychildrenadolescentsGraves’ diseasethyrotoxicosisReferencesRivkees SA. Controversies in the management of Graves&apos; disease in children. J Endocrinol Invest. 2016;39(11): 1247-1257. doi: 10.1007/s40618-016-0477-x.Rivkees SA. Controversies in the management of Graves&apos; disease in children. J Endocrinol Invest. 2016;39(11): 1247-1257. doi: 10.1007/s40618-016-0477-x.Kraiem Z, Newfield RS. Graves&apos; disease in childhood. J Pediatr Endocrinol Metab. 2001;14(3):229-243. doi: 10.1515/JPEM.2001.14.3.229.Kraiem Z, Newfield RS. Graves&apos; disease in childhood. J Pediatr Endocrinol Metab. 2001;14(3):229-243. doi: 10.1515/JPEM.2001.14.3.229.Croom RD, 3rd, Thomas CG, Jr., Reddick RL, Tawil MT. Autonomously functioning thyroid nodules in childhood and adolescence. Surgery. 1987;102(6):1101-1108.Croom RD, 3rd, Thomas CG, Jr., Reddick RL, Tawil MT. Autonomously functioning thyroid nodules in childhood and adolescence. Surgery. 1987;102(6):1101-1108.Niedziela M, Breborowicz D, Trejster E, Korman E. Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients. J Pediatr Endocrinol Metab. 2002;15(6):823-830. doi: 10.1515/JPEM.2002.15.6.823.Niedziela M, Breborowicz D, Trejster E, Korman E. Hot nodules in children and adolescents in western Poland from 1996 to 2000: clinical analysis of 31 patients. J Pediatr Endocrinol Metab. 2002;15(6):823-830. doi: 10.1515/JPEM.2002.15.6.823.Cooper DS. Antithyroid drugs for the treatment of hyperthyroidism caused by Graves&apos; disease. Endocrinol Metab Clin North Am. 1998;27(1):225-247. doi: 10.1016/S0889-8529(05)70308-X.Cooper DS. Antithyroid drugs for the treatment of hyperthyroidism caused by Graves&apos; disease. Endocrinol Metab Clin North Am. 1998;27(1):225-247. doi: 10.1016/S0889-8529(05)70308-X.Glaser NS, Styne DM, Organization of Pediatric Endocrinologists of Northern California Collaborative Graves&apos; Disease Study G. Predicting the likelihood of remission in children with Graves&apos; disease: a prospective, multicenter study. Pediatrics. 2008;121(3):e481-488. doi: 10.1542/peds.2007-1535.Glaser NS, Styne DM, Organization of Pediatric Endocrinologists of Northern California Collaborative Graves&apos; Disease Study G. Predicting the likelihood of remission in children with Graves&apos; disease: a prospective, multicenter study. Pediatrics. 2008;121(3):e481-488. doi: 10.1542/peds.2007-1535.Hamburger JI. Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab. 1985;60(5): 1019-1024. doi: 10.1210/jcem-60-5-1019.Hamburger JI. Management of hyperthyroidism in children and adolescents. J Clin Endocrinol Metab. 1985;60(5): 1019-1024. doi: 10.1210/jcem-60-5-1019.Gruneiro-Papendieck L, Chiesa A, Finkielstain G, Heinrich JJ. Pediatric Graves&apos; disease: outcome and treatment. J Pediatr Endocrinol Metab. 2003;16(9):1249-1255. doi: 10.1515/JPEM.2003.16.9.1249.Gruneiro-Papendieck L, Chiesa A, Finkielstain G, Heinrich JJ. Pediatric Graves&apos; disease: outcome and treatment. J Pediatr Endocrinol Metab. 2003;16(9):1249-1255. doi: 10.1515/JPEM.2003.16.9.1249.Lazar L, Kalter-Leibovici O, Pertzelan A, et al. Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab. 2000;85(10): 3678-3682. doi: 10.1210/jcem.85.10.6922.Lazar L, Kalter-Leibovici O, Pertzelan A, et al. Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab. 2000;85(10): 3678-3682. doi: 10.1210/jcem.85.10.6922.Leger J, Gelwane G, Kaguelidou F, et al. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves&apos; disease: national long-term cohort study. J Clin Endocrinol Metab. 2012;97(1):110-119. doi: 10.1210/jc.2011-1944.Leger J, Gelwane G, Kaguelidou F, et al. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves&apos; disease: national long-term cohort study. J Clin Endocrinol Metab. 2012;97(1):110-119. doi: 10.1210/jc.2011-1944.Jevalikar G, Solis J, Zacharin M. Long-term outcomes of pediatric Graves&apos; disease. J Pediatr Endocrinol Metab. 2014;27(11-12):1131-1136. doi: 10.1515/jpem-2013-0342.Jevalikar G, Solis J, Zacharin M. Long-term outcomes of pediatric Graves&apos; disease. J Pediatr Endocrinol Metab. 2014;27(11-12):1131-1136. doi: 10.1515/jpem-2013-0342.Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9): 905-917. doi: 10.1056/NEJMra042972.Cooper DS. Antithyroid drugs. N Engl J Med. 2005;352(9): 905-917. doi: 10.1056/NEJMra042972.Rivkees SA, Stephenson K, Dinauer C. Adverse events associated with methimazole therapy of Graves&apos; disease in children. Int J Pediatr Endocrinol. 2010;2010:176970. doi: 10.1155/2010/176970.Rivkees SA, Stephenson K, Dinauer C. Adverse events associated with methimazole therapy of Graves&apos; disease in children. Int J Pediatr Endocrinol. 2010;2010:176970. doi: 10.1155/2010/176970.Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: how has granulocyte colony-stimulating factor changed therapy? Thyroid. 2005;15(3):292-297. doi: 10.1089/thy.2005.15.292.Tajiri J, Noguchi S. Antithyroid drug-induced agranulocytosis: how has granulocyte colony-stimulating factor changed therapy? Thyroid. 2005;15(3):292-297. doi: 10.1089/thy.2005.15.292.Razvi S, Vaidya B, Perros P, Pearce SH. What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves&apos; disease. Eur J Endocrinol. 2006;154(6):783-786. doi: 10.1530/eje.1.02169.Razvi S, Vaidya B, Perros P, Pearce SH. What is the evidence behind the evidence-base? The premature death of block-replace antithyroid drug regimens for Graves&apos; disease. Eur J Endocrinol. 2006;154(6):783-786. doi: 10.1530/eje.1.02169.Ron E, Doody MM, Becker DV, et al. Cancer mortality following treatment for adult hyperthyroidism. Cooperative Thyrotoxicosis Therapy Follow-up Study Group. JAMA. 1998;280(4):347-355. doi: 10.1001/jama.280.4.347.Ron E, Doody MM, Becker DV, et al. Cancer mortality following treatment for adult hyperthyroidism. Cooperative Thyrotoxicosis Therapy Follow-up Study Group. JAMA. 1998;280(4):347-355. doi: 10.1001/jama.280.4.347.Harper L, Chin L, Daykin J, et al. Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves&apos; disease. Clin Endocrinol (Oxf). 2004;60(6):671-675. doi: 10.1111/j.1365-2265.2004.02029.x.Harper L, Chin L, Daykin J, et al. Propylthiouracil and carbimazole associated-antineutrophil cytoplasmic antibodies (ANCA) in patients with Graves&apos; disease. Clin Endocrinol (Oxf). 2004;60(6):671-675. doi: 10.1111/j.1365-2265.2004.02029.x.Румянцев П.О., Коренев С.В. История появления терапии радиоактивным йодом. // Клиническая и экспериментальная тиреоидология. – 2015 – Т. 11. – № 4. – С. 51–55. [Rumiantsev PO, Korenev SV. The history of radioiodine therapy beginnings. Clinical and Experimental Thyroidology. 2015;11(4):51-55. (in Russ.)]. doi: 10.14341/ket2015451-55.Румянцев П.О., Коренев С.В. История появления терапии радиоактивным йодом. // Клиническая и экспериментальная тиреоидология. – 2015 – Т. 11. – № 4. – С. 51–55. [Rumiantsev PO, Korenev SV. The history of radioiodine therapy beginnings. Clinical and Experimental Thyroidology. 2015;11(4):51-55. (in Russ.)]. doi: 10.14341/ket2015451-55.Dobyns BM, Sheline GE, Workman JB, et al. Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: a report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab. 1974;38(6):976-998. doi: 10.1210/jcem-38-6-976.Dobyns BM, Sheline GE, Workman JB, et al. Malignant and benign neoplasms of the thyroid in patients treated for hyperthyroidism: a report of the cooperative thyrotoxicosis therapy follow-up study. J Clin Endocrinol Metab. 1974;38(6):976-998. doi: 10.1210/jcem-38-6-976.Safa AM, Schumacher OP, Rodriguez-Antunez A. Long-term follow-up results in children and adolescents treated with radioactive iodine (131I) for hyperthyroidism. N Engl J Med. 1975;292(4):167-171. doi: 10.1056/NEJM197501232920401.Safa AM, Schumacher OP, Rodriguez-Antunez A. Long-term follow-up results in children and adolescents treated with radioactive iodine (131I) for hyperthyroidism. N Engl J Med. 1975;292(4):167-171. doi: 10.1056/NEJM197501232920401.Brandao CD, Miranda AE, Correa ND, et al. Radioiodine therapy and subsequent pregnancy. Arq Bras Endocrinol Metabol. 2007;51(4):534-540. doi: 10.1590/S0004-27302007000400006.Brandao CD, Miranda AE, Correa ND, et al. Radioiodine therapy and subsequent pregnancy. Arq Bras Endocrinol Metabol. 2007;51(4):534-540. doi: 10.1590/S0004-27302007000400006.Sandeep TC, Strachan MW, Reynolds RM, et al. Second primary cancers in thyroid cancer patients: a multinational record linkage study. J Clin Endocrinol Metab. 2006;91(5): 1819-1825. doi: 10.1210/jc.2005-2009.Sandeep TC, Strachan MW, Reynolds RM, et al. Second primary cancers in thyroid cancer patients: a multinational record linkage study. J Clin Endocrinol Metab. 2006;91(5): 1819-1825. doi: 10.1210/jc.2005-2009.Румянцев П.О., Ильин А.А., Румянцева У.В., Саенко В.А. Рак щитовидной железы. Современные подходы к диагностике и лечению. М.: ГЭОТАР-Медиа; 2009. 448 p. [Rumyantsev PO, Ilyin AA, Rumyantseva UV, Saenko VA. Rak shchitovidnoy zhelezy. Sovremennye podkhody k diagnostike i lecheniyu. Moscow: GEOTAR-Media; 2009. 448 p. (in Russ.)]Румянцев П.О., Ильин А.А., Румянцева У.В., Саенко В.А. Рак щитовидной железы. Современные подходы к диагностике и лечению. М.: ГЭОТАР-Медиа; 2009. 448 p. [Rumyantsev PO, Ilyin AA, Rumyantseva UV, Saenko VA. Rak shchitovidnoy zhelezy. Sovremennye podkhody k diagnostike i lecheniyu. Moscow: GEOTAR-Media; 2009. 448 p. (in Russ.)]Boice JD, Jr. Thyroid disease 60 years after Hiroshima and 20 years after Chernobyl. JAMA. 2006;295(9):1060-1062. doi: 10.1001/jama.295.9.1060.Boice JD, Jr. Thyroid disease 60 years after Hiroshima and 20 years after Chernobyl. JAMA. 2006;295(9):1060-1062. doi: 10.1001/jama.295.9.1060.Sheline GE, Lindsay S, Bell HG. Occurrence of thyroid nodules in children following therapy with radioiodine for hyperthyroidism. J Clin Endocrinol Metab. 1959;19(1):127-137. doi: 10.1210/jcem-19-1-127.Sheline GE, Lindsay S, Bell HG. Occurrence of thyroid nodules in children following therapy with radioiodine for hyperthyroidism. J Clin Endocrinol Metab. 1959;19(1):127-137. doi: 10.1210/jcem-19-1-127.Read CH, Jr., Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves&apos; patients. J Clin Endocrinol Metab. 2004;89(9):4229-4233. doi: 10.1210/jc.2003-031223.Read CH, Jr., Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves&apos; patients. J Clin Endocrinol Metab. 2004;89(9):4229-4233. doi: 10.1210/jc.2003-031223.Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves&apos; disease is radioiodine. J Clin Endocrinol Metab. 2007;92(3):797-800. doi: 10.1210/jc.2006-1239.Rivkees SA, Dinauer C. An optimal treatment for pediatric Graves&apos; disease is radioiodine. J Clin Endocrinol Metab. 2007;92(3):797-800. doi: 10.1210/jc.2006-1239.Maxon HR, Thomas SR, Hertzberg VS, et al. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med. 1983;309(16):937-941. doi: 10.1056/NEJM198310203091601.Maxon HR, Thomas SR, Hertzberg VS, et al. Relation between effective radiation dose and outcome of radioiodine therapy for thyroid cancer. N Engl J Med. 1983;309(16):937-941. doi: 10.1056/NEJM198310203091601.Graham GD, Burman KD. Radioiodine treatment of Graves&apos; disease. An assessment of its potential risks. Ann Intern Med. 1986;105(6):900-905. doi: 10.7326/0003-4819-105-6-900.Graham GD, Burman KD. Radioiodine treatment of Graves&apos; disease. An assessment of its potential risks. Ann Intern Med. 1986;105(6):900-905. doi: 10.7326/0003-4819-105-6-900.Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics. 2003;111(4 Pt 1):745-749. doi: 10.1515/JPEM.2002.15.6.823.Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics. 2003;111(4 Pt 1):745-749. doi: 10.1515/JPEM.2002.15.6.823.Kadmon PM, Noto RB, Boney CM, et al. Thyroid storm in a child following radioactive iodine (RAI) therapy: a consequence of RAI versus withdrawal of antithyroid medication. J Clin Endocrinol Metab. 2001;86(5):1865-1867. doi: 10.1210/jcem.86.5.7473.Kadmon PM, Noto RB, Boney CM, et al. Thyroid storm in a child following radioactive iodine (RAI) therapy: a consequence of RAI versus withdrawal of antithyroid medication. J Clin Endocrinol Metab. 2001;86(5):1865-1867. doi: 10.1210/jcem.86.5.7473.Ross DS, Daniels GH, De Stefano P, et al. Use of adjunctive potassium iodide after radioactive iodine (131I) treatment of Graves&apos; hyperthyroidism. J Clin Endocrinol Metab. 1983;57(2):250-253. doi: 10.1210/jcem-57-2-250.Ross DS, Daniels GH, De Stefano P, et al. Use of adjunctive potassium iodide after radioactive iodine (131I) treatment of Graves&apos; hyperthyroidism. J Clin Endocrinol Metab. 1983;57(2):250-253. doi: 10.1210/jcem-57-2-250.Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3): 456-520. doi: 10.1089/thy.2010.0417.Bahn RS, Burch HB, Cooper DS, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3): 456-520. doi: 10.1089/thy.2010.0417.Barnes HV, Blizzard RM. Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr. 1977;91(2):313-320. doi: 10.1016/S0022-3476(77)80843-3.Barnes HV, Blizzard RM. Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr. 1977;91(2):313-320. doi: 10.1016/S0022-3476(77)80843-3.Miccoli P, Vitti P, Rago T, et al. Surgical treatment of Graves&apos; disease: subtotal or total thyroidectomy? Surgery. 1996;120(6):1020-1024; discussion 1024-1025. doi: 10.1016/S0039-6060(96)80049-3.Miccoli P, Vitti P, Rago T, et al. Surgical treatment of Graves&apos; disease: subtotal or total thyroidectomy? Surgery. 1996;120(6):1020-1024; discussion 1024-1025. doi: 10.1016/S0039-6060(96)80049-3.Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves&apos; disease: a 2014 update. J Endocrinol Invest. 2014;37(8):691-700. doi: 10.1007/s40618-014-0097-2.Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves&apos; disease: a 2014 update. J Endocrinol Invest. 2014;37(8):691-700. doi: 10.1007/s40618-014-0097-2.

The authors declare that there are no conflicts of interest present.