Radioiodine or thyroidectomy in children and adolescents with Graves' disease: a structured literature review of efficacy and safety.

Graves' disease (GD) is the most common cause of hyperthyroidism in children and adolescents. When remission is not achieved with antithyroid drugs, definitive treatment with radioiodine therapy (RAI) or thyroidectomy is recommended. We conducted a structured literature review of studies indexed in PubMed/MEDLINE to evaluate the efficacy and safety of these approaches in the paediatric population. Twenty-one studies including 9,490 patients were analysed. RAI achieved high remission rates (85-96%), with hypothyroidism representing the expected therapeutic outcome. Thyroidectomy provided definitive disease control in the vast majority of patients, with recurrence mainly associated with subtotal procedures. The most frequent surgical complication was transient hypocalcaemia (16.9%), while permanent hypoparathyroidism was rare (0.79%). RAI was generally associated with infrequent reported adverse events, such as transient sialadenitis, and long-term data did not show increased risks of malignancy or reproductive complications. Overall, available observational evidence suggests that both RAI and total thyroidectomy are effective definitive treatments for paediatric GD. In the absence of randomized comparative studies, treatment choice should be individualized according to patient age, thyroid characteristics, institutional expertise, and patient and family preferences.