Assignment Task:
A 14-year-old female presents with a 3-month history of weight loss, increased appetite, irregular menses, and difficulty sleeping. Her mother reports she has been irritable and had had poor performance in school. Her mother comments that her daughter's anterior neck appears larger. She is diagnosed with Grave's disease.
Graves disease is the most common cause of hyperthyroidism in children and adults. It is an autoimmune condition in which antibodies bind and activate the thyrotropin (also known as thyroid-stimulating hormone or TSH) receptor. Graves disease accounts for more than 95% of childhood and adolescent cases of hyperthyroidism, with a peak incidence of 11 to 15 years of age (female predominance).
Graves disease may occur in conjunction with other autoimmune diseases, including type 1 diabetes mellitus, hypoparathyroidism, Addison disease, myasthenia gravis, vitiligo, and pernicious anemia.
Symptoms include weight loss, heat intolerance, difficulty sleeping, tremor, increased frequency of defecation, irritability, and menstrual irregularity. Children may also present with behavioral disturbances, including decreased attention span, difficulty concentrating, emotional lability, and hyperactivity.
On physical exam, the thyroid gland in Graves disease is usually diffusely enlarged with a soft texture and a well-delineated border. Cardiovascular findings include tachycardia, palpitations, and widened pulse pressure. Atrial fibrillation is a common presenting symptom in patients over 50 years of age. Neuromuscular findings include tremors, a shortened relaxation phase in deep tendon reflexes, fatigue, and proximal muscle weakness.
The mother asks you for the best treatment for her daughter. You describe the 3 modalities for treating hyperthyroidism and contact your pediatric endocrinology colleagues.
What are the 3 modalities available for the treatment of Graves disease?