hyperthyroidism and the safety of radioiodine in children
TRANSCRIPT
Dr Jenny WorrallIS RADIOIODINE SAFE
IN CHILDREN?
Delivered as oral capsule or solution
Active isotope I131
Uptake by thyroid glandβ particle releaseDestruction of follicular
cells
WHAT IS RADIOIODINE?
Used to treat disorders of the thyroid gland Hyperthyroidism Thyroid cancer
Concerns about radiation exposure
Caution in adopting radioiodine therapy
Divided approaches to treatment of
hyperthyroidism
Enabling clinicians, patients and families to
make informed choices
WHY IS IT IMPORTANT?
Overactive thyroid gland
Graves’ disease: 95% of cases
Common features:
Palpitations Tremor Restlessness/Poor concentration Fatigue Insomnia GI Upset Eye problems Goitre
HYPERTHYROIDISM
MANAGEMENT OPTIONS
β Blocker
Antithyroid medications (eg carbimazole)
Surgical resection
Radioiodine
14 year old femaleDiagnosed with Graves’ age 8Shaky, nervous, anxious, thirsty and hungryMild goitre & eye signsTreated with Carbimazole 30mg/dayTrial without aged 11 – returnedConcern about side effects of antithyroid medication –
opted for radioiodine treatment
CASE STUDY
Radiation: I131
Increased risk thyroid cancer:
Highest amongst youngestRisk 3x greater in iodine
deficient areas Increased risk up to dose
of 2Gy
CHERNOBYLA LESSON FROM HISTORY: EFFECTS OF
EXTERNAL EXPOSURE TO RADIATION
CHERNOBYL
Immediate effects:
Vomiting, thyroiditis, thyroid nodulesHypothyroidism (90%)Thyroid storm: tachycardia, jaundice,
dehydration, agitation, confusion
SAFETY OF THERAPEUTIC RADIOIODINE
LONG TERM EFFECTS OF RADIOIODINE
• No increased risk• Deficiency, dose, lethality
Thyroid malignancy
• e.g. leukaemia• Risk matched that for surgical approach
Other malignancies
• No increased risk to offspring • Developing foetus – hypothyroidismRisk to
offspring
• Worsened in up to 15% of adults• No evidence that this is true for children
Ophthalmology
Little evidence that therapeutic radioiodine is associated with increased long-term risk
Definitive treatment – rapid resolution of symptoms
Should be one of a range of options offered to patients and their families as first line treatment
CONCLUSION
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