THE JOURNAL OF PEDIATRICS WONG, SCHLAGGAR,AND LANDT

VOLUME 138, NUMBER 3

How often does a CSF pleocytosis fol-low generalized convulsions? AnnNeurol 1983;13:460-2.

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50 Years Ago in The Journal of PediatricsTREATMENT OF HYPERTHYROIDISM WITH RADIOACTIVE IODINE

Forbes GB, Perley AM. J Pediatr 1951;38:158-63

The treatment of hyperthyroidism continues to be controversial because there are significant complicationswith all therapeutic options. Thionamide therapy (propylthiouracil, methimazole) is associated with long-term remission rates of 30% to 50%, and complication rates of 20% to 30%. Surgery has a 90% cure rate butis a complex procedure with risks including permanent hypoparathyroidism or vocal cord paralysis. Long-term cure rates of 90% in adults with hyperthyroidism can be achieved after radioactive iodine treatment. In1951, Forbes and Perley reported the treatment of hyperthyroidism in an 11-year-old girl with a single dose ofradioiodine. The hyperthyroidism failed to respond to thionamide treatment (noncompliance), and the patientwas a poor candidate for surgery because of previous rheumatic fever. After treatment with radioactive io-dine, the basal metabolic rate (there were no thyroxine assays in 1951) declined, and the size of the thyroidgland decreased. Ten weeks after treatment, she had no signs or symptoms of hyperthyroidism and subse-quently received thyroid hormone replacement. The authors acknowledged their concern about the long-termrisk of carcinogenic effects from the radioiodine treatment.

Childhood survivors of atomic explosions in Japan, fallout after nuclear weapons testing in the Marshall Is-lands, and the Chernobyl disaster have had an increased incidence of thyroid carcinoma. Children less than10 years of age at the time of exposure had the highest risk. The risk of thyroid cancer in children receivingtreatment for hyperthyroidism with radioactive iodine is unknown. Children less than l0 years may be atgreater risk. It is recommended that children should receive higher doses of iodine 131 to minimize residualthyroid tissue and decrease the risk of thyroid cancer. Patients with Graves’ disease, in general, are at higherrisk for thyroid cancer regardless of treatment modality. All patients with a history of Graves’ disease shouldhave careful follow-up, and newly appearing nodules should be biopsied or excised.

Robert P. Schwartz, MDDepartment of PediatricsSection of Endocrinology

Wake Forest University School of MedicineWinston-Salem, NC 27157

9/37/113041doi:10.1067/mpd.2001.113041

REFERENCE1. Rivkees SA, Sklar C, Freemark M. The management of Graves’ disease in children, with special emphasis on

radioiodine treatment. J Clin Endocrinol Metab 1998;83:3767-76.