Children and young people are usually treated with antithyroid drugs (ATD) that reduce the production of thyroid hormone. The drug given is usually carbimazole. If your child cannot tolerate carbimazole, they may be given propylthiouracil (PTU) – see Hyperthyroidism - About Antithyroid Drugs for more information.
To bring everything under control quickly your child is likely to be given a high starting dose of antithyroid drug. Their endocrinologist will review this after about three to eight weeks, by giving them a blood test. The drug dose might be reduced if there is an improvement. Children will usually continue taking the drugs for about eighteen months to three years. Then they will be taken off the treatment to see if the hyperthyroidism is cured. Your child will have to go for regular blood tests, probably every two to six months. The dose may be adjusted throughout this period.
The antithyroid drug can be used in one of two ways. The first way is a dose titration (DT) regime, where the dose of the antithyroid drug is adjusted to control the amount of hormone released by the thyroid gland.
The dose may need to be adjusted if your child develops symptoms of hypothyroidism (see Hashimoto’s Thyroiditis - Symptoms).
The second way to use the antithyroid drug is as part of a block and replace (BR) regimen: the antithyroid drug blocks the thyroid gland from producing any thyroxine. Levothyroxine is then given to your child to replace their natural thyroxine. It has been argued that the BR regimen may result in more stable control although using carbimazole alone as part of a dose titration approach will tend to be associated with fewer side-effects because the dose of antithyroid drug tends to be smaller.
Unfortunately, Graves’ disease can return after treatment with ATD. If your child’s blood tests are within the reference range for a year after treatment, they will need no further check-ups other than the occasional thyroid blood test. However, it is important to see your GP and to ask for a blood test if you notice a recurrence of any symptoms of hyperthyroidism. If it does come back, your child may be given another course of ATD. Alternatively, they can have thyroid surgery or radioactive iodine (RAI) treatment. Your child’s endocrinologist or paediatric endocrinologist may arrange an appointment with the specialist surgeon and the doctor who is in charge of radioactive iodine treatment to discuss the options in more detail. It is very much a question of getting the right treatment for your child and the options (another course of ATD, surgery or radioactive iodine treatment) will depend on your child’s circumstances. Once you have discussed these with the specialist surgeon and the doctor who is in charge of radioactive iodine treatment, you can decide which treatment to choose.