Comparing Antithyroid Drugs vs. Radioactive Iodine in Paediatric Graves’: Literature Review

Introduction: Paediatric Graves’ disease (PGD) is an autoimmune condition, which if left untreated, can result in cardiac complications. NICE Guidance (NG145) advocates the use of antithyroid drugs (ATD) as first-line therapy for PGD, with a consultation to consider a move to definitive therapy in the form of radioactive iodine (RAI) or thyroidectomy if the initial 2-year course failed to achieve normal thyroid function. We aim to explore the effectiveness and associated adverse events (AEs) of ATD compared with RAI. Methods A thorough guideline search of NICE Evidence and RCP guidelines & Policy was conducted to yield a guideline relevant to our review question. A literature search of the Cochrane Library, MEDLINE, EMBASE and PubMed, alongside a clear inclusion and exclusion criteria was utilised to generate systematic reviews and primary literature exploring the efficacy and AEs of ATD and RAI. Our guideline, systematic reviews and primary literature were appraised using AGREE-II, AMSTAR 2 and CASP respectively. Results The search strategy yielded one NICE guideline (NG145) published in November 2019, two systematic reviews published after November 2019 and four primary studies, published after the most recent systematic review (August 2020). All studies determined that ATD and RAI are both effective treatment options for PGD. With regards to AEs, RAI and ATD were considered to be safe treatment options, with the latter having the least severity of complications. Conclusions In patients who have been identified to have predictors of remission, we agree with NG145 and ATD should be offered as first-line treatment. However, for those who do not have characteristics aligning with the predictors of remission, RAI should be offered as first-line therapy. We suggest screening of predictors of remission to aid the choice of treatment in paediatric Graves’ disease treatment.