Treatment of juvenile Graves' disease and its ophthalmic complication: the 'European way'

Three treatment modalities are available for Graves' disease: antithyroid drugs, surgery and radioactive iodine (RAI). None has been shown to be ideal or superior to the others. There are wide differences between individual physicians and between the physicians in different countries on the optional treatment for childhood hyperthyroidism. While antithyroid drugs remain the initial treatment of choice in almost all the medical centers in Europe, with surgery being used mainly to deal with antithyroid failures, radioiodine is preferred by only a small percentage of physicians for this group of patients. In the USA, on the contrary, radioiodine treatment of thyrotoxicosis in children has strong advocates, who emphasize the safety, simplicity and economic advantages of iodine-131 ablation, which should be considered more commonly in children. Until now, the available data have shown no significant increase in thyroid neoplasia, gonadal injury or congenital abnormalities in the offspring of older children and adults receiving RAI for thyrotoxicosis. Given the considerable increase in the risk of thyroid cancer in young children exposed to external radiation, it has been hypothesized that there may be a small increase in the risk of thyroid cancer in young children treated with RAI. Until long-term data on safety are available, specifically for young children, differences between the physicians in different countries will remain.