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Radioiodine treatment for pediatric Graves' disease

  • Review
  • Intervention

Authors


Abstract

Background

Pediatric Graves' disease (GD) is an autoimmune disease in which excessive amounts of thyroid hormones circulate in the blood. Treatments for pediatric GD include antithyroid drugs (ATD), thyroidectomy and radioiodine. Up to date, the optimal therapy remains controversial.

Objectives

To assess the effects of radioiodine treatment for pediatric GD.

Search methods

Studies were obtained from computerized searches of MEDLINE, EMBASE, The Cochrane Library, China National Infrastructure (CNKI) and paper collections of conferences held in Chinese.

Selection criteria

Randomised controlled trials, controlled clinical trials and prospective cohort studies comparing the effects of radioiodine with ATD or thyroidectomy with a duration of follow-up at least one year.

Data collection and analysis

Two authors independently assessed study quality, extracted data and interviewed authors of all potentially relevant studies by telephone or electronic mail to verify randomization procedures. One author entered data into a data extraction form and another author verified the results of this procedure.

Main results

Two prospective controlled clinical trials involving 167 patients were included. All of them were of low quality. Radioiodine treatment versus ATD showed benefits in achieving euthyroidism (relative risk (RR) 1.70, 95% confidence interval (CI) 1.29 to 2.24). Radioiodine treatment showed a higher incidence of hypothyroidism compared with ATD (RR 6.46, 95% CI 1.16 to 35.81). No significant differences in modifying Graves' opthalmopathy (worsening or appearance) between radioiodine treatment and ATD (RR 1.30, 95% CI 0.56 to 3.00) were observed. No trial evaluated mortality, health related quality of life, economic outcomes or compliance with treatments.

Authors' conclusions

The limited results in Chinese suggest that a gland specific lower dosage of radioiodine treatment is potentially effective for pediatric GD, but a significant higher incidence of hypothyroidism compared with ATD was observed. However, we could not identify a well-designed trial to provide strong evidence for radioiodine in the treatment of pediatric GD. High-quality randomised controlled clinical trials are needed to guide treatment choice.

摘要

背景

以放射性碘治療小兒葛瑞夫斯病(Graves' disease)

小兒葛瑞夫斯病(GD)是一種血液中有過量甲狀腺激素的自體免疫性疾病。治療小兒葛瑞夫斯病的方法包括抗甲狀腺藥物(ATD),甲狀腺切除以及放射性碘治療。到目前為止,最好的治療方法仍在爭議中。

目標

評估放射性碘治療小兒葛瑞夫斯病的效果。

搜尋策略

研究搜尋了MEDLINE、EMBASE、Cochrane Library、中國期刊全文數據庫(China National Infrastructure, CNKI),以及在中國舉行之研討會之文獻集。

選擇標準

比較放射性碘治療與抗甲狀腺藥物或甲狀腺切除的療效,且至少追蹤一年之隨機對照實驗、對照臨床實驗及前瞻性世代研究。

資料收集與分析

兩位作者獨立評估研究的品質,摘錄數據並透過電話或電子郵件採訪有關研究的作者以驗證實驗隨機化程序。一位作者將數據輸入特定格式之表單,另一位作者負責檢查輸入資料是否有誤。

主要結論

選取包共含167名病人的兩個前瞻性對照臨床試驗。兩個研究的品質都不佳。放射性碘治療比抗甲狀腺藥物能讓甲狀腺機能恢復正常(RR 1.70,95% CI 1.29 – 2.24),但也更容易造成甲狀腺功能不足(RR 6.46,95% CI 1.16 �35.81),在葛瑞夫斯眼病變之影響(惡化或表現)則沒有顯著差異(RR 1.30,95% CI 0.56 �3.00)。兩個研究都沒有評估其死亡率、健康有關的生活品質、花費之影響及患者對治療之順從度。

作者結論

有限的中文研究結果顯示,依照個別腺體情況而定之低劑量的放射性碘治療對於小兒葛瑞夫斯病有潛在之療效,但因此而產生甲狀腺功能低下之比例較抗甲狀腺藥物治療為高。我們無法找出一個設計良好,足以支持以放射線碘治療小兒葛瑞夫斯病之臨床研究。須有高品質的隨機對照臨床試驗結果以提供選擇治療方式的依據。

翻譯人

本摘要由慈濟醫院謝至鎠翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

以放射性碘治療小兒葛瑞夫斯病:葛瑞夫斯病是兒童和青少年血液循環含過量甲狀腺激素,甲狀腺功能亢進常見的原因。受影響的兒童和青少年會有心跳加快,皮膚溫暖潮濕,疲勞,體重下降,體溫增加,眼睛及其他部位的問題。可以使用放射性碘,手術切除甲狀腺或控制甲狀腺激素產生的藥物(抗甲狀腺藥物)來治療。本回顧共分析包含167個病例的兩個相關研究。有限的數據顯示,依照個別腺體情況而定之低劑量的放射性碘治療對於小兒葛瑞夫斯病有潛在之療效,但因此而產生甲狀腺功能低下之比例較抗甲狀腺藥物治療為高。然而所有可供分析之研究品質不佳,沒有研究評估其死亡率,健康有關的生活品質,花費之影響及對治療之順從度。

Plain language summary

Radioiodine treatment for pediatric Graves' disease

Graves' disease is a common cause of hyperthyroidism in children and adolescents which excessive amounts of thyroid hormones circulating in the blood. Affected children and adolescents suffer from increased heart beats, warm moist skin, fatigue, weight loss, raised body temperature, eye and other problems. Application of radioactive iodine (radioiodine), surgical removal of the thyroid gland or drugs that interfere with the production of thyroid hormones (antithyroid drugs) are used to treat this disease.
Two relevant trials with 167 patients were identified. The limited data suggest that a gland specific lower dosage of radioiodine treatment is potentially effective for pediatric GD, but a significant higher incidence of hypothyroidism compared with ATD was observed. However, all of the analysed studies were of low quality. No trial evaluated mortality, health related quality of life, economic outcomes or compliance with treatments.

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