problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl13086problendo-13086Research ArticleДетская эндокринологияPediatric EndocrinologyРадикальное лечение диффузного токсического зоба у детей.Definitive treatment of Graves’ disease in childrenhttps://orcid.org/0000-0002-4541-7673ИванниковаТ. Е.IvannikovaT. E.

Иванникова Татьяна Егвгеньевна

117036, Москва, ул. Дм. Ульянова, д. 11

SPIN-код: 8933-5723

Tatyana E. Ivannikova

11 Dm. Ulyanova street, 117036 Moscow

SPIN-код: 8933-5723

ivannikovate@yandex.ruhttps://orcid.org/0000-0002-2604-1703ШиряеваТ. Ю.ShiryaevaT. Yu.

Ширяева Татьяна Юрьевна, кандидат медицинских наук

Москва

SPIN-код: 1322-0042

Tatyana Yu. Shiryaeva, MD, PhD

Moscow

SPIN-код: 1322-0042

tasha-home@list.ruhttps://orcid.org/0000-0001-6429-7198НагаеваЕ. В.NagaevaE. V.

Нагаева Елена Витальевна, доктор медицинских наук

Москва

SPIN-код: 4878-7810

Elena V. Nagaeva, MD, PhD

Moscow

SPIN-код: 4878-7810

nagaeva_ev@mail.ruhttps://orcid.org/0000-0003-3785-0335ШереметаМ. С.SheremetaM. S.

Шеремета Марина Сергеевна, кандидат медицинских наук

Москва

SPIN-код:7845-2194

Marina S. Sheremeta, MD, PhD

Moscow

SPIN-код:7845-2194

marina888@yandex.ruhttps://orcid.org/0000-0002-3734-6510БровинД. Н.BrovinD. N.

Бровин Дмитрий Николаевич, кандидат медицинских наук

Москва

SPIN-код: 2518-9054

Dmitry N. Brovin, MD, PhD

Moscow

SPIN-код: 2518-9054

d.brovin@mail.ruhttps://orcid.org/0000-0001-9621-5732БезлепкинаО. Б.BezlepkinaO. B.

Безлепкина Ольга Борисовна, доктор медицинских наук

Москва

SPIN-код: 3884-0945

Olga B. Bezlepkina, MD, PhD

Moscow

SPIN-код: 3884-0945

olgabezlepkina@mail.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202230042022682104111Copyright © Иванникова Т.Е., Ширяева Т.Ю., Нагаева Е.В., Шеремета М.С., Бровин Д.Н., Безлепкина О.Б., 20222022Иванникова Т.Е., Ширяева Т.Ю., Нагаева Е.В., Шеремета М.С., Бровин Д.Н., Безлепкина О.Б.Ivannikova T.E., Shiryaeva T.Y., Nagaeva E.V., Sheremeta M.S., Brovin D.N., Bezlepkina O.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/13086ОБОСНОВАНИЕ

ОБОСНОВАНИЕ. Гипертиреоз, вызванный диффузным токсическим зобом (ДТЗ), является относительно редким заболеванием у детей. Существует два метода его лечения: консервативный, т.е. медикаментозная терапия, и радикальный: хирургическое лечение и радиойодтерапия (РЙТ). При неэффективности медикаментозной терапии рассматривается вопрос выбора радикального метода лечения: РЙТ или тотальной тиреоидэктомии.

ЦЕЛЬ

ЦЕЛЬ. Оценка результатов радикального лечения детей с диффузным токсическим зобом.

МАТЕРИАЛЫ И МЕТОДЫ

МАТЕРИАЛЫ И МЕТОДЫ. Ретроспективное и проспективное одноцентровое исследование, включающее 122 пациента с диффузным токсическим зобом, в том числе с узловыми образованиями на фоне ДТЗ, которым было проведено радикальное лечение (с 2016 г. по 2021 г.).

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Средний возраст на момент обследования составлял 13,5±3,5 года. Пациенты были разделы на 2 группы в зависимости от проведенного лечения: 1-ю группу (n=60) составили дети, которым проведено оперативное лечение, 2-ю группу (n=62) — дети, которым проведена РЙТ. Медиана дозы тиреостатических препаратов у детей обеих групп достоверно не различалась (р=0,06), дети, которым была проведена РЙТ, получали тиреостатическую терапию достоверно более длительное время (p=0,024). Эндокринная офтальмопатия (ЭОП) имелась у 58 детей (47,5%) и встречалась одинаково часто в обеих группах, однако активная стадия ЭОП имелась только у детей 1-й группы. У детей 1-й группы объем щитовидной железы был достоверно больше (р=0,004), только в 1-й группе имелись узловые образования щитовидной железы (p=0,0007).

ЗАКЛЮЧЕНИЕ

ЗАКЛЮЧЕНИЕ. РЙТ можно считать эффективным и безопасным методом лечения ДТЗ. Эффективность РЙТ зависит в том числе от объема щитовидной железы, согласно результатам построенной ROC-кривой, риск повторного применений РЙТ выше при объеме более 55 см3. Также нежелательно проведение РЙТ при наличии офтальмопатии в связи с возможным ухудшением течения ЭОП. При оперативном лечении в раннем послеоперационном периоде в 20% случаев отмечался гипопаратиреоз, 5% — парез возвратного гортанного нерва. Пациентам с выявленными узловыми образованиями по результатам УЗИ предпочтительно проводить оперативное лечение в связи с невозможностью исключить рак щитовидной железы.

BACKGROUND

BACKGROUND: Hyperthyreoidism due to Graves’ disease is a rare disorder in pediatric practice. There is 2 treatment options in Graves’ disease: medical treatment and definitive treatment, including surgery and radioactive iodine. Each method has its advantages and disadvantages. If medical therapy is ineffective the choice between radical treatment method is raised: radioactive iodine or total thyroidectomy. In this research we analyze treatment outcomes in pediatric Graves’ disease patients after different radical treatment methods.

AIM

AIM: Comparative analysis of radical treatment outcomes in pediatric patients with Graves’ disease.

MATERIALS AND METHODS

MATERIALS AND METHODS: Retrospective and prospective one-center research of 122 patients with Graves’ disease after radical treatment (between 2016 and 2021)

RESULTS

RESULTS: The mean age was 13.5±3,5 year at the moment of examination. Patients were divided into 2 groups due to the radical treatments method: 1 group (n=60) were children after surgical treatment, 2 group (n=62) — after radioactive iodine. The mean dose of medical treatment in these groups did not reliably differ (p=0,06), duration of the medical treatment was reliably longer in patients after radioactive iodine (p=0,024). Graves’ orbitopathy was diagnosed in 58 patients (47,5%) and met equally often in both groups, but active stage of Graves’ orbitopathy was diagnosed only in patients from the 1st group. Thyroid size was reliable bigger in patients from the 1st group (p=0,004), and thyroid gland nodes were diagnosed only in patients from 1st group (p=0,0007).

CONCLUSION

CONCLUSION: RI can be considered an effective and safe treatment for GD. The effectiveness of RI depends on the volume of the thyroid gland; according to the results of the constructed ROC curve, the risk of repeated RI is higher with a volume of more than 55 cm3. Also radioactive iodine is undesirable if there is signs of ophatalmopathy due to its possible deterioration. According to the results of the study hypoparathyroidism after surgical treatment was diagnosed in 20%, recurrent laryngeal nerve injury was diagnosed after surgical treatment in 5% of patients. In patients with identified nodular goiter according to the results of ultrasound, surgical treatment is preferable due to the impossibility of excluding thyroid cancer.

диффузный токсический зобгипертиреозтиреоидэктомиярадиойодтерапияGraves’ diseasehyperthyroidismthyroidectomyradioactive iodineReferencesAbraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899-905. doi: https://doi.org/10.1530/EJE-11-0548Abraham-Nordling M, Byström K, Törring O, et al. Incidence of hyperthyroidism in Sweden. Eur J Endocrinol. 2011;165(6):899-905. doi: https://doi.org/10.1530/EJE-11-0548Simon M, Rigou A, Le Moal J, et al. Epidemiology of Childhood Hyperthyroidism in France: A Nationwide Population-Based Study. J Clin Endocrinol Metab. 2018;103(8):2980-2987. doi: https://doi.org/10.1210/jc.2018-00273Simon M, Rigou A, Le Moal J, et al. Epidemiology of Childhood Hyperthyroidism in France: A Nationwide Population-Based Study. J Clin Endocrinol Metab. 2018;103(8):2980-2987. doi: https://doi.org/10.1210/jc.2018-00273Williamson S, Greene SA. Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland. Clin Endocrinol (Oxf). 2010;72(3):358-363. doi: https://doi.org/10.1111/j.1365-2265.2009.03717.xWilliamson S, Greene SA. Incidence of thyrotoxicosis in childhood: a national population based study in the UK and Ireland. Clin Endocrinol (Oxf). 2010;72(3):358-363. doi: https://doi.org/10.1111/j.1365-2265.2009.03717.xKaguelidou F, Alberti C, Castanet M, et al. Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment. J Clin Endocrinol Metab. 2008;93(10):3817-3826. doi: https://doi.org/10.1210/jc.2008-0842Kaguelidou F, Alberti C, Castanet M, et al. Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment. J Clin Endocrinol Metab. 2008;93(10):3817-3826. doi: https://doi.org/10.1210/jc.2008-0842Wong GWK, Cheng PS. Increasing incidence of childhood Graves’ disease in Hong Kong: A follow-up study. Clin Endocrinol (Oxf). 2001;54(4):547-550. doi: https://doi.org/10.1046/j.1365-2265.2001.01252.xWong GWK, Cheng PS. Increasing incidence of childhood Graves’ disease in Hong Kong: A follow-up study. Clin Endocrinol (Oxf). 2001;54(4):547-550. doi: https://doi.org/10.1046/j.1365-2265.2001.01252.xRodanaki M, Lodefalk M, Forssell K, et al. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019;91(3):195-202. doi: https://doi.org/10.1159/000500265Rodanaki M, Lodefalk M, Forssell K, et al. The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden. Horm Res Paediatr. 2019;91(3):195-202. doi: https://doi.org/10.1159/000500265Федеральные клинические рекомендации (протоколы) по ведению детей с эндокринными заболеваниями / Под ред. И.И. Дедова, В.А. Петерковой. — М.: Практика; 2014. С. 215-239.Federal’nye klinicheskie rekomendatsii (protokoly) po vedeniyu detei s endokrinnymi zabolevaniyami. Ed by Dedov II, Peterkova VA. — Moscow: Praktika; 2014. P. 215-239. (In Russ.).Безлепкина О.Б. Федеральные клинические рекомендации по диагностике и лечению болезни Грейвса у детей // Проблемы Эндокринологии. — 2014. — Т. 60. — №3. — С. 59-68. doi: https://doi.org/10.14341/probl201460359-68БBezlepkina OB. Federal clinical recommendations on diagnostics and treatment of Graves’ disease in the children. Problems of Endocrinology. 2014;60(3):59-68. (In Russ.). doi: https://doi.org/10.14341/probl201460359-68van Lieshout JM, Mooij CF, van Trotsenburg ASP, Zwaveling-Soonawala N. Methimazole-induced remission rates in pediatric Graves’ disease: a systematic review. Eur J Endocrinol. 2021;185(2):219-229. doi: https://doi.org/10.1530/EJE-21-0077van Lieshout JM, Mooij CF, van Trotsenburg ASP, Zwaveling-Soonawala N. Methimazole-induced remission rates in pediatric Graves’ disease: a systematic review. Eur J Endocrinol. 2021;185(2):219-229. doi: https://doi.org/10.1530/EJE-21-0077Kaguelidou F, Alberti C, Castanet M, et al. Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment. J Clin Endocrinol Metab. 2008;93(10):3817-3826. doi: https://doi.org/10.1210/jc.2008-0842Kaguelidou F, Alberti C, Castanet M, et al. Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment. J Clin Endocrinol Metab. 2008;93(10):3817-3826. doi: https://doi.org/10.1210/jc.2008-0842Léger J, Gelwane G, Kaguelidou F, et al. Positive Impact of Long-Term Antithyroid Drug Treatment on the Outcome of Children with Graves’ Disease: National Long-Term Cohort Study. J Clin Endocrinol Metab. 2012;97(1):110-119. doi: https://doi.org/10.1210/jc.2011-1944Léger J, Gelwane G, Kaguelidou F, et al. Positive Impact of Long-Term Antithyroid Drug Treatment on the Outcome of Children with Graves’ Disease: National Long-Term Cohort Study. J Clin Endocrinol Metab. 2012;97(1):110-119. doi: https://doi.org/10.1210/jc.2011-1944Гостимский А.В., Передереев С.С. Современные проблемы хирургического лечения больных диффузным токсическим зобом детского возраста // Педиатр. — 2013. — №4. — С. 69-76.Gostimskii AV, Peredereev SS. Sovremennye problemy khirurgicheskogo lecheniya bol’nykh diffuznym toksicheskim zobom detskogo vozrasta. Pediatr. 2013;4:69-76. (In Russ.).Румянцев П.О., Кияев А.В., Шеремета М.В., Чикулаева О.А. Радиойодтерапия тиротоксикоза у детей. Показания, эффективность и безопасность. Обзор литературы // Эндокринная хирургия. — 2016. — Т. 10. — №4. — С. 6-12. doi: https://doi.org/10.14341/serg201646-12Rumiantsev PO, Kiyaev AV, Sehemeta MS, Chikulaeva OA. Radioiodine therapy of thyrotoxicosis in children and adolescents. Indications, efficacy and safety. Literature review. Endocrine Surgery. 2016;10(4):6-12. (In Russ.). doi: https://doi.org/10.14341/serg201646-12Bahn RS. Graves’ Ophthalmopathy. N Engl J Med. 2010;362(8):726-738. doi: https://doi.org/10.1056/NEJMra0905750;Bahn RS. Graves’ Ophthalmopathy. N Engl J Med. 2010;362(8):726-738. doi: https://doi.org/10.1056/NEJMra0905750;Prasai A, Nix PA, Aye M, et al. Total thyroidectomy for safe and definitive management of Graves’ disease. J Laryngol Otol. 2013;127(7):681-684. doi: https://doi.org/10.1017/S0022215113001254Prasai A, Nix PA, Aye M, et al. Total thyroidectomy for safe and definitive management of Graves’ disease. J Laryngol Otol. 2013;127(7):681-684. doi: https://doi.org/10.1017/S0022215113001254Quérat C, Germain N, Dumollard J-M, et al. Surgical management of hyperthyroidism. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(2):63-66. doi: https://doi.org/10.1016/j.anorl.2014.04.005Quérat C, Germain N, Dumollard J-M, et al. Surgical management of hyperthyroidism. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(2):63-66. doi: https://doi.org/10.1016/j.anorl.2014.04.005Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: https://doi.org/10.1002/bjs.9384Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: https://doi.org/10.1002/bjs.9384Burch HB, Cooper DS. Management of Graves Disease. JAMA. 2015;314(23):2544-2554. doi: https://doi.org/10.1001/jama.2015.16535Burch HB, Cooper DS. Management of Graves Disease. JAMA. 2015;314(23):2544-2554. doi: https://doi.org/10.1001/jama.2015.16535Genovese BM, Noureldine SI, Gleeson EM, et al. What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature. Ann Surg Oncol. 2013;20(2):660-667. doi: https://doi.org/10.1245/s10434-012-2606-xGenovese BM, Noureldine SI, Gleeson EM, et al. What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature. Ann Surg Oncol. 2013;20(2):660-667. doi: https://doi.org/10.1245/s10434-012-2606-xBrito JP, Schilz S, Singh Ospina N, et al. Antithyroid Drugs—The Most Common Treatment for Graves’ Disease in the United States: A Nationwide Population-Based Study. Thyroid. 2016;26(8):1144-1145. doi: https://doi.org/10.1089/thy.2016.0222Brito JP, Schilz S, Singh Ospina N, et al. Antithyroid Drugs—The Most Common Treatment for Graves’ Disease in the United States: A Nationwide Population-Based Study. Thyroid. 2016;26(8):1144-1145. doi: https://doi.org/10.1089/thy.2016.0222Aung ET, Zammitt NN, Dover AR, et al. Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis. Clin Endocrinol (Oxf). 2019;90(1):192-199. doi: https://doi.org/10.1111/cen.13873Aung ET, Zammitt NN, Dover AR, et al. Predicting outcomes and complications following radioiodine therapy in Graves’ thyrotoxicosis. Clin Endocrinol (Oxf). 2019;90(1):192-199. doi: https://doi.org/10.1111/cen.13873Sirianong N, Kevalee U, Prapai D, et al. Radioactive Iodine for Thyrotoxicosis in Childhood and Adolescence: Treatment and Outcomes. J Clin Res Pediatr Endocrinol. 2013;5(2):95-97. doi: https://doi.org/10.4274/Jcrpe.951Sirianong N, Kevalee U, Prapai D, et al. Radioactive Iodine for Thyrotoxicosis in Childhood and Adolescence: Treatment and Outcomes. J Clin Res Pediatr Endocrinol. 2013;5(2):95-97. doi: https://doi.org/10.4274/Jcrpe.951Azizi F, Amouzegar A. Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients. J Pediatr Endocrinol Metab. 2018;31(2):159-165. doi: https://doi.org/10.1515/jpem-2017-0394Azizi F, Amouzegar A. Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients. J Pediatr Endocrinol Metab. 2018;31(2):159-165. doi: https://doi.org/10.1515/jpem-2017-0394Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome. J Clin Endocrinol Metab. 2001;86(8):3611-3617. doi: https://doi.org/10.1210/jcem.86.8.7781Allahabadia A, Daykin J, Sheppard MC, et al. Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome. J Clin Endocrinol Metab. 2001;86(8):3611-3617. doi: https://doi.org/10.1210/jcem.86.8.7781Prasai A, Nix PA, Aye M, et al. Total thyroidectomy for safe and definitive management of Graves’ disease. J Laryngol Otol. 2013;127:681-684. doi: https://doi.org/10.1017/S0022215113001254Prasai A, Nix PA, Aye M, et al. Total thyroidectomy for safe and definitive management of Graves’ disease. J Laryngol Otol. 2013;127:681-684. doi: https://doi.org/10.1017/S0022215113001254Quérat C, Germain N, Dumollard J-M, et al. Surgical management of hyperthyroidism. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(2):63-66. doi: https://doi.org/10.1016/j.anorl.2014.04.005Quérat C, Germain N, Dumollard J-M, et al. Surgical management of hyperthyroidism. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(2):63-66. doi: https://doi.org/10.1016/j.anorl.2014.04.005Phitayakorn R, Morales-Garcia D, Wanderer J, et al. Surgery for Graves’ disease: a 25-year perspective. Am J Surg. 2013;206(5):669-673. doi: https://doi.org/10.1016/j.amjsurg.2013.07.005Phitayakorn R, Morales-Garcia D, Wanderer J, et al. Surgery for Graves’ disease: a 25-year perspective. Am J Surg. 2013;206(5):669-673. doi: https://doi.org/10.1016/j.amjsurg.2013.07.005Catania A, Guaitoli E, Carbotta G, et al. Total thyroidectomy for Graves’ disease treatment. Clin Ter. 2013;164:193-196. doi: https://doi.org/10.7417/CT.2013.1548Catania A, Guaitoli E, Carbotta G, et al. Total thyroidectomy for Graves’ disease treatment. Clin Ter. 2013;164:193-196. doi: https://doi.org/10.7417/CT.2013.1548Genovese BM, Noureldine SI, Gleeson EM, et al. What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature. Ann Surg Oncol. 2013;20(2):660-667. doi: https://doi.org/10.1245/s10434-012-2606-xGenovese BM, Noureldine SI, Gleeson EM, et al. What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature. Ann Surg Oncol. 2013;20(2):660-667. doi: https://doi.org/10.1245/s10434-012-2606-xLiu ZW, Masterson L, Fish B, Jani P, Chatterjee K. Thyroid surgery for Graves’ disease and Graves’ ophthalmopathy. Cochrane Database Syst Rev. 2015. doi: https://doi.org/10.1002/14651858.CD010576.pub2Liu ZW, Masterson L, Fish B, Jani P, Chatterjee K. Thyroid surgery for Graves’ disease and Graves’ ophthalmopathy. Cochrane Database Syst Rev. 2015. doi: https://doi.org/10.1002/14651858.CD010576.pub2Burch HB, Cooper DS. Management of Graves Disease. JAMA. 2015;314(23):2544-2554. doi: https://doi.org/10.1001/jama.2015.16535Burch HB, Cooper DS. Management of Graves Disease. JAMA. 2015;314(23):2544-2554. doi: https://doi.org/10.1001/jama.2015.16535Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: https://doi.org/10.1002/bjs.9384Edafe O, Antakia R, Laskar N, et al. Systematic review and meta-analysis of predictors of post-thyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: https://doi.org/10.1002/bjs.9384Oltmann SC, Brekke AV, Schneider DF, et al. Preventing Postoperative Hypocalcemia in Patients with Graves Disease: A Prospective Study. Ann Surg Oncol. 2015;22(3):952-958. doi: https://doi.org/10.1245/s10434-014-4077-8Oltmann SC, Brekke AV, Schneider DF, et al. Preventing Postoperative Hypocalcemia in Patients with Graves Disease: A Prospective Study. Ann Surg Oncol. 2015;22(3):952-958. doi: https://doi.org/10.1245/s10434-014-4077-8Bellantone R, Lombardi CP, Bossola M, et al. Total thyroidectomy for management of benign thyroid disease: Review of 526 cases. World J Surg. 2002;26(12):1468-1471. doi: https://doi.org/10.1007/s00268-002-6426-1Bellantone R, Lombardi CP, Bossola M, et al. Total thyroidectomy for management of benign thyroid disease: Review of 526 cases. World J Surg. 2002;26(12):1468-1471. doi: https://doi.org/10.1007/s00268-002-6426-1Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg. 2009;52(1):39-44.Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg. 2009;52(1):39-44.Desforges JF, Mazzaferri EL. Management of a Solitary Thyroid Nodule. N Engl J Med. 1993;328(8):553-559. doi: https://doi.org/10.1056/NEJM199302253280807Desforges JF, Mazzaferri EL. Management of a Solitary Thyroid Nodule. N Engl J Med. 1993;328(8):553-559. doi: https://doi.org/10.1056/NEJM199302253280807Tufano RP, Noureldine SI, Angelos P. Incidental Thyroid Nodules and Thyroid Cancer. JAMA Otolaryngol Neck Surg. 2015;141(6):566. doi: https://doi.org/10.1001/jamaoto.2015.0647Tufano RP, Noureldine SI, Angelos P. Incidental Thyroid Nodules and Thyroid Cancer. JAMA Otolaryngol Neck Surg. 2015;141(6):566. doi: https://doi.org/10.1001/jamaoto.2015.0647Wei S, Baloch ZW, LiVolsi VA. Thyroid Carcinoma in Patients with Graves’ Disease: an Institutional Experience. Endocr Pathol. 2015;26(1):48-53. doi: https://doi.org/10.1007/s12022-014-9343-6Wei S, Baloch ZW, LiVolsi VA. Thyroid Carcinoma in Patients with Graves’ Disease: an Institutional Experience. Endocr Pathol. 2015;26(1):48-53. doi: https://doi.org/10.1007/s12022-014-9343-6Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016;12(11):646-653. doi: https://doi.org/10.1038/nrendo.2016.110Kitahara CM, Sosa JA. The changing incidence of thyroid cancer. Nat Rev Endocrinol. 2016;12(11):646-653. doi: https://doi.org/10.1038/nrendo.2016.110McLeod DSA, Watters KF, Carpenter AD, et al. Thyrotropin and Thyroid Cancer Diagnosis: A Systematic Review and Dose-Response Meta-Analysis. J Clin Endocrinol Metab. 2012;97(8):2682-2692. doi: https://doi.org/10.1210/jc.2012-1083McLeod DSA, Watters KF, Carpenter AD, et al. Thyrotropin and Thyroid Cancer Diagnosis: A Systematic Review and Dose-Response Meta-Analysis. J Clin Endocrinol Metab. 2012;97(8):2682-2692. doi: https://doi.org/10.1210/jc.2012-1083Boostrom S, Richards ML. Total thyroidectomy is the preferred treatment for patients with Graves’ disease and a thyroid nodule. Otolaryngol Neck Surg. 2007;136(2):278-281. doi: https://doi.org/10.1016/j.otohns.2006.09.011Boostrom S, Richards ML. Total thyroidectomy is the preferred treatment for patients with Graves’ disease and a thyroid nodule. Otolaryngol Neck Surg. 2007;136(2):278-281. doi: https://doi.org/10.1016/j.otohns.2006.09.011Rinaldi S, Plummer M, Biessy C, et al. Thyroid-Stimulating Hormone, Thyroglobulin, and Thyroid Hormones and Risk of Differentiated Thyroid Carcinoma: The EPIC Study. JNCI J Natl Cancer Inst. 2014;106(6). doi: https://doi.org/10.1093/jnci/dju097Rinaldi S, Plummer M, Biessy C, et al. Thyroid-Stimulating Hormone, Thyroglobulin, and Thyroid Hormones and Risk of Differentiated Thyroid Carcinoma: The EPIC Study. JNCI J Natl Cancer Inst. 2014;106(6). doi: https://doi.org/10.1093/jnci/dju097Huang H, Rusiecki J, Zhao N, et al. Thyroid-Stimulating Hormone, Thyroid Hormones, and Risk of Papillary Thyroid Cancer: A Nested Case–Control Study. Cancer Epidemiol Biomarkers Prev. 2017;26(8):1209-1218. doi: https://doi.org/10.1158/1055-9965.EPI-16-0845Huang H, Rusiecki J, Zhao N, et al. Thyroid-Stimulating Hormone, Thyroid Hormones, and Risk of Papillary Thyroid Cancer: A Nested Case–Control Study. Cancer Epidemiol Biomarkers Prev. 2017;26(8):1209-1218. doi: https://doi.org/10.1158/1055-9965.EPI-16-0845Dal Maso L, Bosetti C, La Vecchia C, Franceschi S. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control. 2009;20(1):75-86. doi: https://doi.org/10.1007/s10552-008-9219-5Dal Maso L, Bosetti C, La Vecchia C, Franceschi S. Risk factors for thyroid cancer: an epidemiological review focused on nutritional factors. Cancer Causes Control. 2009;20(1):75-86. doi: https://doi.org/10.1007/s10552-008-9219-5Shaha AR. Controversies in the Management of Thyroid Nodule. Laryngoscope. 2000;110(2):183-183. doi: https://doi.org/10.1097/00005537-200002010-00001Shaha AR. Controversies in the Management of Thyroid Nodule. Laryngoscope. 2000;110(2):183-183. doi: https://doi.org/10.1097/00005537-200002010-00001Becker D V. Choice of Therapy for Graves’ Hyperthyroidism. N Engl J Med. 1984;311(7):464-466. doi: https://doi.org/10.1056/NEJM198408163110710Becker D V. Choice of Therapy for Graves’ Hyperthyroidism. N Engl J Med. 1984;311(7):464-466. doi: https://doi.org/10.1056/NEJM198408163110710Kung AW, Yau CC, Cheng A. The incidence of ophthalmopathy after radioiodine therapy for Graves’ disease: prognostic factors and the role of methimazole. J Clin Endocrinol Metab. 1994;79(2):542-546. doi: https://doi.org/10.1210/jcem.79.2.7913934Kung AW, Yau CC, Cheng A. The incidence of ophthalmopathy after radioiodine therapy for Graves’ disease: prognostic factors and the role of methimazole. J Clin Endocrinol Metab. 1994;79(2):542-546. doi: https://doi.org/10.1210/jcem.79.2.7913934Bartalena L, Marcocci C, Bogazzi F, et al. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med. 1998;338:73-78. doi: https://doi.org/10.1056/NEJM199801083380201Bartalena L, Marcocci C, Bogazzi F, et al. Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med. 1998;338:73-78. doi: https://doi.org/10.1056/NEJM199801083380201Rivkees SA, Dinauer C. An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine. J Clin Endocrinol Metab. 2007;92(3):797-800. doi: https://doi.org/10.1210/jc.2006-1239Rivkees SA, Dinauer C. An Optimal Treatment for Pediatric Graves’ Disease Is Radioiodine. J Clin Endocrinol Metab. 2007;92(3):797-800. doi: https://doi.org/10.1210/jc.2006-1239

The authors declare that there are no conflicts of interest present.