{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:38:21Z","timestamp":1791041901387,"version":"4.1.0"},"reference-count":32,"publisher":"Walter de Gruyter GmbH","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,1,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2017-0394_s_999_w2aab3b7c54b1b6b1aab1c16b1Aa\">\n                  <jats:title>Background:<\/jats:title>\n                  <jats:p>Diffuse toxic goiter accounts for about 15% of all childhood thyroid diseases. There is great controversy over the management of Graves\u2019 disease in children and adolescents. This article reports our experience in 304 children and juvenile patients with Graves\u2019 disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2017-0394_s_998_w2aab3b7c54b1b6b1aab1c16b2Aa\">\n                  <jats:title>Methods:<\/jats:title>\n                  <jats:p>Between 1981 and 2015, 304 patients aged 5\u201319 years with diffuse toxic goiter were studied, of whom 296 patients were treated with antithyroid drugs (ATD) for 18 months. Patients with persistent or relapsed hyperthyroidism who refused ablative therapy with surgery or radioiodine were managed with continuous methimazole (MMI) treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2017-0394_s_997_w2aab3b7c54b1b6b1aab1c16b3Aa\">\n                  <jats:title>Results:<\/jats:title>\n                  <jats:p>In 304 patients (245 females and 59 males), the mean age was 15.6\u00b12.6 years. After 18 months of ATD therapy, 37 remained in remission and of the 128 who relapsed, two, 29 and 97 patients chose surgery, continuous ATD and radioiodine therapy, respectively. Of the 136 patients who received radioiodine, 66.2% became hypothyroid. Twenty-nine patients received continuous ATD therapy for 5.7\u00b12.4 years. The mean MMI dose was 4.6\u00b112 mg daily, no serious complications occurred and all of them remained euthyroid during the follow-up. Less abnormal thyroid-stimulating hormone (TSH) values were observed in these patients, as compared to patients who were on a maintenance dose of levothyroxine after radioiodine induced hypothyroidism.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2017-0394_s_996_w2aab3b7c54b1b6b1aab1c16b4Aa\">\n                  <jats:title>Conclusions:<\/jats:title>\n                  <jats:p>Original treatment with ATD and subsequent radioiodine therapy remain the mainstay of treatment for juvenile hyperthyroidism. Continuous ATD administration may be considered as another treatment modality for hyperthyroidism.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2017-0394","type":"journal-article","created":{"date-parts":[[2018,1,7]],"date-time":"2018-01-07T22:16:33Z","timestamp":1515363393000},"page":"159-165","source":"Crossref","is-referenced-by-count":21,"title":["Management of thyrotoxicosis in children and adolescents: 35 years\u2019 experience in 304 patients"],"prefix":"10.1515","volume":"31","author":[{"given":"Fereidoun","family":"Azizi","sequence":"first","affiliation":[{"name":"Endocrine Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , I.R. Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atieh","family":"Amouzegar","sequence":"additional","affiliation":[{"name":"Endocrine Research Center, Research Institute for Endocrine Sciences , Shahid Beheshti University of Medical Sciences , Tehran , I.R. Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2018,1,8]]},"reference":[{"key":"2021021317335160294_j_jpem-2017-0394_ref_001_w2aab3b7c54b1b6b1ab2b2b1Aa","doi-asserted-by":"crossref","unstructured":"Zimmerman D, Lteif AN. Thyrotoxicosis in children. Endocrinol Metab Clin North Am. 1998;27:109\u201326.","DOI":"10.1016\/S0889-8529(05)70302-9"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_002_w2aab3b7c54b1b6b1ab2b2b2Aa","unstructured":"Braverman LE, Cooper D, editors. Werner & Ingbar\u2019s. The thyroid: A fundamental and clinical text, 7th ed. Philadelphia: Lippincott-Williams & Wilkins, 2000."},{"key":"2021021317335160294_j_jpem-2017-0394_ref_003_w2aab3b7c54b1b6b1ab2b2b3Aa","doi-asserted-by":"crossref","unstructured":"Forssberg M, Arvidsson CG, Engvall J, Lindblad C, Snellman K, et al. Increasing incidence of childhood thyrotoxicosis in a population-based area of central Sweden. Acta Paediatr 2004;93:25\u20139.","DOI":"10.1111\/j.1651-2227.2004.tb00669.x"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_004_w2aab3b7c54b1b6b1ab2b2b4Aa","doi-asserted-by":"crossref","unstructured":"Havgaard Kjaer R, Smedegard Andersen M, Hansen D. Increasing incidence of juvenile thyrotoxicosis in Denmark: a nationwide study, 1998\u20132012. Horm Res Paediatr 2015;84:102\u20137.","DOI":"10.1159\/000430985"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_005_w2aab3b7c54b1b6b1ab2b2b5Aa","doi-asserted-by":"crossref","unstructured":"Barnes HV, Blizzard RM. Antithyroid drug therapy for toxic diffuse goiter (Graves disease): thirty years experience in children and adolescents. J Pediatr 1977;91:313\u201320.","DOI":"10.1016\/S0022-3476(77)80843-3"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_006_w2aab3b7c54b1b6b1ab2b2b6Aa","unstructured":"L\u00e9ger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol 2013;5(Suppl 1):50\u20136."},{"key":"2021021317335160294_j_jpem-2017-0394_ref_007_w2aab3b7c54b1b6b1ab2b2b7Aa","doi-asserted-by":"crossref","unstructured":"Read Jr CH, Tansey MJ, Menda Y. A 36-year retrospective analysis of the efficacy and safety of radioactive iodine in treating young Graves\u2019 patients. J Clin Endocrinol Metab 2004;89: 4229\u201333.","DOI":"10.1210\/jc.2003-031223"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_008_w2aab3b7c54b1b6b1ab2b2b8Aa","unstructured":"Fisher DA. Graves\u2019 disease in children. Curr Ther Endocrinol Metab 1994;5:71\u20134."},{"key":"2021021317335160294_j_jpem-2017-0394_ref_009_w2aab3b7c54b1b6b1ab2b2b9Aa","doi-asserted-by":"crossref","unstructured":"Nebesio TD, Siddiqui AR, Pescovitz OH, Eugster EA. Time course to hypothyroidism after fixed-dose radioablation therapy of Graves\u2019 disease in children. J Pediatr 2002;141: 99\u2013103.","DOI":"10.1067\/mpd.2002.125494"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_010_w2aab3b7c54b1b6b1ab2b2c10Aa","doi-asserted-by":"crossref","unstructured":"Safa AM, Schumacher OP, Rodriguez-Antunez A. Long-term follow-up results in children and adolescents treated with radioactive iodine (131I) for hyperthyroidism. N Engl J Med 1975;292:167\u201371.","DOI":"10.1056\/NEJM197501232920401"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_011_w2aab3b7c54b1b6b1ab2b2c11Aa","unstructured":"Starr P, Jaffe HL, Oettinger L, Jr. Late results of I-131 treatment of hyperthyroidism in seventy-three children and adolescents. J Nucl Med 1964;5:81\u20139."},{"key":"2021021317335160294_j_jpem-2017-0394_ref_012_w2aab3b7c54b1b6b1ab2b2c12Aa","doi-asserted-by":"crossref","unstructured":"Rivkees SA, Cornelius EA. Influence of iodine-131 dose on the outcome of hyperthyroidism in children. Pediatrics 2003;111:745\u20139.","DOI":"10.1542\/peds.111.4.745"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_013_w2aab3b7c54b1b6b1ab2b2c13Aa","doi-asserted-by":"crossref","unstructured":"Metso S, Jaatinen P, Huhtala H, Auvinen A, Oksala H, Salmi J. Increased cardiovascular and cancer mortality after radioiodine treatment for hyperthyroidism. J Clin Endocrinol Metab 2007;92:2190\u20136.","DOI":"10.1210\/jc.2006-2321"},{"key":"2021021317335160294_j_jpem-2017-0394_ref_014_w2aab3b7c54b1b6b1ab2b2c14Aa","doi-asserted-by":"crossref","unstructured":"Shore RE. Issues and epidemiological evidence regarding radiation-induced thyroid cancer. 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