Tratamento da Doença de Graves na infância e adolescência

Abstract

BACKGROUND: Graves' disease (GD) is the most common cause of hyperthyroidism in children. It is present in about 0.5% of the general population and affects more females in the proportion of 5 to 10:1. DG is an autoimmune disease that results from the production of autoantibodies antitireperoxidase (ATPO) antithyroglobulin (anti-TG) and antibodies directed against the TSH receptor, known as TRAb (thyrotropin receptor antibody). The primary antibody responsible for the pathophysiology of DG is TRAb and it can be found in 90% of patients. The clinical presentation is usually insidious and the symptoms can be subtle for several months. The laboratory diagnosis of hyperthyroidism is performed by the finding of TSH suppression associated with elevation of total T4, free T4 and free T3 and free, and there may be more significant change in the levels of T3 than T4. Although the diagnosis of DG in childhood and adolescence is relatively easy, its treatment remains controversial. Among the options are: the use of antithyroid drugs like methimazole (MTZ) or propylthiouracil (PTU), surgery and radiotherapy with radioiodine. OBJECTIVES: The objective of this study is to compare the remission rate and duration of treatment for: radioiodine and antithyroid drugs and evaluate the indication of radioiodine treatment in children and adolescents with DG. CAUSUÍSTICAS AND METHODS: This study was conducted by collecting data from medical records of children and adolescents with GD who were followed in the clinic São Vicente Serviço de Endocrinologia da Faculdade de Medicina de Minas Gerais (UFMG) from August 2010 to February 2011. We evaluated a total of 20 children aged between 4-16 years. The diagnostic method was used for DG Chemiluminescence TSH to dose (0.6 to 5.4 mIU / L), free T4 (0.7 - 1.5 ng / dl) and radioimmunoassay to quantitate JOB (up to 10%). We evaluated: duration of treatment with antithyroid drugs, the reason for suspending of treatment with antithyroid drug and remission after treatment (radioactive iodine / antithyroid drugs) by calculating the averages, standard deviations and, where possible, comparison between these averages. RESULTS: Of the 20 charts analyzed 14 (70%) were female and 6 (30%) were male. All children started treatment with antithyroid drugs. They have used MMZ 18 (90%) and PTU 3 (15%). The remission rate after the use of DAT was 30%. One patient had an adverse reaction to both the MMZ (skin rash) and with PTU (skin rash), one patient had leukopenia after PTU, a child with neutropenia after the use of MMZ. Treatment with radioactive iodine (I¹³¹) was nominated for 12 (60%) children. The mean dose of I¹³¹ used was 10.67 mCi. All children who used radioactive iodine therapy had remission of GD. CONCLUSION: Treatment of DG in childhood and adolescence presents many controversies. Radioiodine therapy has been increasingly used. Some studies have shown that this therapy is safe for use in children, but studies are needed in the long term. Children do not have a good therapeutic response to DAT and still exposed to risks of serious side effects and can often be lethal, and finally, in most cases, turns out to be necessary to use the radioiodine.