Surgical management of thyrotoxicosis in children.

S INCE THE INTRODUCTION of thyroid blocking agents 20 years ago there has been a continuing controversy over the best form of treatment for thyrotoxicosis in children. In terms of ease, expense, and short-term safety there is no doubt that radioactive iodine is superior to either subtotal thyroidectomy or the administration of antithyroid drugs. The potential hazard of radioactive iodine are the induction of thyroid cancer, leukemia, genetic damage, and permanent hypothyroidism. The magnitude of these risks in childhood is unknown and this uncertainty has prompted most centers including ours to restrict this form of therapy to adults and the rare instances in children when the use of the other forms of treatment is contraindicated. Some very well-respected clinicians are using radioiodine in children. Their long-term resuhs will either vindicate or abolish the fears of the majority. Since long-term followup will be required to determine the answer to the most threatening fears, we must wait and decide among the other modalities at hand. Management of this disease process with drugs requires a prolonged period of administration and close supervision by the physician. At best only a 60-75 per cent incidence of permanent remission has been achieved. It has been the feeling of our institution that subtotal thyroidectomy would be the preferred form of therapy if the euthyroid state could be consistently attained with an absence of mortality and a minimum of m0rbidity.l Twenty-three years of experience at the University of Michigan Medical Center with bilateral subtotal thyroidectomy for thyrotoxicosis in children was reviewed in order to make this decision.