The management of pediatric Graves' disease.

IF 1.9 4区 医学 Q2 OTORHINOLARYNGOLOGY
Lourdes Quintanilla-Dieck
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引用次数: 0

Abstract

Purpose of review: Graves' disease (GD) constitutes a significant proportion of thyroid disorders seen during childhood. Several specialties may be closely involved in the management of pediatric patients with GD and emerging research in each field contributes to variations in the approach over time. Here we review the recent literature on the management of the disease, with the hope that this can be a valuable resource for treating specialists who need to be continuously updated on new data obtained in relevant fields.

Recent findings: Genetic, postinfectious and environmental factors may play a role in the immunological pathophysiology of GD. Research performed during the COVID-19 pandemic supports that viral-induced immune dysregulation may be a possible trigger for the disease. The various current treatment options all have positive and negative factors to consider. Antithyroidal drug therapy (ATD) is generally recommended as the initial treatment, although remission rates are only 20-30% at 2 years and 75% at 9 years. Unfortunately, about half of patients will relapse within 1 year of discontinuing therapy. Radioactive iodine therapy (RAI) is an effective treatment option and can be considered in certain pediatric patients. There continues to be no definitive evidence that the doses used for GD lead to a higher risk of cancer. Surgical treatment via thyroidectomy is effective and safe when performed by a high-volume surgeon. Recent studies show improvement in quality-of-life after surgery in adolescents and young adults. Future medical treatment options for GD currently being studied include antigen-specific immunotherapy and monoclonal antibodies.

Summary: Although the future holds promising new therapeutic options for autoimmune diseases including GD, the current choices continue to be ATD, usually first-line, and definitive treatments including RAI and surgery. While all three offer the possibility of remission or cure, drug therapy and RAI have a possibility of relapse. Risks of each approach should be broached in detail with patients and their families, and the nuances of treating this disease specifically in children should be familiar to all treating providers.

小儿Graves病的治疗。
综述目的:Graves病(GD)在儿童期甲状腺疾病中占很大比例。几个专业可能密切参与GD儿科患者的管理,每个领域的新兴研究都会导致方法随着时间的推移而发生变化。在这里,我们回顾了最近关于该疾病管理的文献,希望这能成为治疗专家的宝贵资源,这些专家需要不断更新相关领域获得的新数据。最近的发现:遗传、感染后和环境因素可能在GD的免疫病理生理学中发挥作用。在新冠肺炎大流行期间进行的研究表明,病毒诱导的免疫失调可能是该疾病的诱因。目前的各种治疗方案都有积极和消极的因素需要考虑。抗甲状腺药物治疗(ATD)通常被建议作为初始治疗,尽管2岁时的缓解率仅为20-30% 9岁时为75% 年。不幸的是,大约一半的患者会在1 停止治疗的一年。放射性碘治疗(RAI)是一种有效的治疗选择,可以考虑用于某些儿科患者。仍然没有明确的证据表明用于GD的剂量会导致更高的癌症风险。由大容量外科医生进行甲状腺切除术的手术治疗是有效和安全的。最近的研究表明,青少年和年轻人手术后的生活质量有所改善。目前正在研究的GD的未来治疗方案包括抗原特异性免疫疗法和单克隆抗体。摘要:尽管未来对包括GD在内的自身免疫性疾病有着很有希望的新治疗选择,但目前的选择仍然是ATD,通常是一线治疗,以及包括RAI和手术在内的最终治疗。虽然这三种药物都有缓解或治愈的可能性,但药物治疗和RAI有复发的可能性。每种方法的风险都应该与患者及其家人详细讨论,所有治疗提供者都应该熟悉专门在儿童身上治疗这种疾病的细微差别。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
96
审稿时长
6-12 weeks
期刊介绍: Current Opinion in Otolaryngology & Head and Neck Surgery is a bimonthly publication offering a unique and wide ranging perspective on the key developments in the field. Each issue features hand-picked review articles from our team of expert editors. With eleven disciplines published across the year – including maxillofacial surgery, head and neck oncology and speech therapy and rehabilitation – every issue also contains annotated references detailing the merits of the most important papers.
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