ESPE Yearbook of Paediatric Endocrinology

Brief summary: Treatment of Graves’ disease comprises anti-thyroid drugs, radioactive iodine ablation or total thyroidectomy (1,2). While definitive treatment of Graves’ disease is widely used in adults, anti-thyroid drug treatment is often used in the pediatric age group over years (1,2). The presented prospective monocenter study provides detailed information on quality of life of adolescents undergoing total thyroidectomy.

Two recent studies on quality of life in adults showed significant improvement in quality of life after total thyroidectomy for hyperthyroidism (3,4). Halada et al. present for the first time prospective data on quality of life in children and adolescents between 12 and 19 years, thyroidectomized for Graves’ disease in a tertiary care center by high volume thyroid surgeons. Eleven of 20 patients had poorly controlled Graves’ disease preoperatively. Patients and parents completed the surveys. The authors used the following five questionnaires for assessing quality of life of patients with Graves’ disease before and after total thyroidectomy: Pediatric Quality of Life Scales (PedsQL), the Quality of Life Questionnaire for Patients with Thyroid Disease (ThyPRO), the Perceived Stigmatization Questionnaire (PSQ), the Body Esteem Scale for Adolescents and Adults (BESAA), and the European Group on Graves’ Orbitopathy GO Quality of Life Questionnaire (EUGOGO-QOL). Significant improvements after total thyroidectomy were observed for the following parameters: goitre resolution, hyperthyroid symptoms, tiredness, cognitive impairment, anxiety, physical and school related functioning. Further, median time to full recovery was reported by parents after two months.

Despite the limitation of the small sample size, this first prospective pediatric study provides important results and suggests that not only biochemical stability of the disease but also measures of quality of life in this age group should be considered for optimal treatment. Further, discussion on definitive treatment by total thyroidectomy of Graves’ disease should have a place in the ongoing care of children and adolescents with Graves’ disease, especially in those with poor control.

References: 1. 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343–1421. doi: 10.1089/thy.2016.0229. PMID: 27521067. 2. 2022 European Thyroid Association Guideline for the management of pediatric Graves' disease. Mooij CF, Cheetham TD, Verburg FA, Eckstein A, Pearce SH, Léger J, van Trotsenburg ASP. 2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease. Eur Thyroid J. 2022 Jan 1;11(1):e210073. doi: 10.1530/ETJ-21-0073. PMID: 34981748. 3. Patient-Reported Outcomes Following Total Thyroidectomy for Graves' Disease. Gunn AH, Frisco N, Thomas SM, Stang MT, Scheri RP, Kazaure HS. Patient-reported outcomes following total thyroidectomy for Graves’ disease. Thyroid. 2022 Jan;32(1):54–64. doi: 10.1089/thy.2021.0285. Epub 2021 Dec 3. PMID: 34663089. 4. Impaired Quality of Life After Radioiodine Therapy Compared to Antithyroid Drugs or Surgical Treatment for Graves' Hyperthyroidism: A Long-Term Follow-Up with the Thyroid-Related Patient-Reported Outcome Questionnaire and 36-Item Short Form Health Status Survey.Törring O, Watt T, Sjölin G, Byström K, Abraham-Nordling M, Calissendorff J, Cramon PK, Filipsson Nyström H, Hallengren B, Holmberg M, Khamisi S, Lantz M, Wallin G. Impaired quality of life after radioiodine therapy compared to antithyroid drugs or surgical treatment for Graves’ hyperthyroidism: A long-term follow-up with the thyroid-related patient-reported outcome Questionnaire and 36-item short form health status survey. Thyroid. 2019 Mar;29(3):322–331. doi: 10.1089/thy.2018.0315. PMID: 30667296.