If Antithyroid Drugs Are Chosen as Initial Management of GD in Children, How Should the Therapy Be Managed?
R51. Methimazole should be used in virtually every child who is treated with antithyroid drug therapy. 1/++0
R52. Pediatric patients and their caretakers should be informed of side effects of antithyroid drugs and the necessity of stopping the medication immediately and informing their physician if they develop pruritic rash, jaundice, acolic stools or dark urine, arthralgias, abdominal pain, nausea, fatigue, fever, or pharyngitis. 1/+00
R53. Prior to initiating antithyroid drug therapy, the task force suggests that pediatric patients have, as a baseline, complete blood cell count, including white blood cell count with differential, and a liver profile including bilirubin, transaminases, and alkaline phosphatase. 2/+00
R54. Beta-adrenergic blockade is recommended for children experiencing symptoms of hyperthyroidism, especially those with heart rates in excess of 100 beats per minute. 1/+00
R55. Antithyroid medication should be stopped immediately, and white blood counts measured in children who develop fever, arthralgias, mouth sores, pharyngitis, or malaise. 1/+00
R56. When propylthiouracil is used in children, the medication should be stopped immediately and liver function and hepatocellular integrity assessed in children who experience anorexia, pruritus, rash, jaundice, light-colored stool or dark urine, joint pain, right upper quadrant pain or abdominal bloating, nausea or malaise. 1/+00
R57. Persistent minor cutaneous reactions to methimazole therapy in children should be managed by concurrent antihistamine treatment or cessation of the medication and changing to therapy with radioactive iodine or surgery. In the case of a serious allergic reaction to an antithyroid medication, prescribing the other antithyroid drug is not recommended. 1/+00
R58. If methimazole is chosen as the first-line treatment for GD in children, it should be administered for 1–2 years and then discontinued, or the dose reduced, to assess whether the patient is in remission. 1/++0
R59. Pediatric patients with GD who are not in remission following 1–2 years of methimazole therapy should be considered for treatment with radioactive iodine or thyroidectomy. 1/+00