Radioactive iodine therapy in the management of pediatric Graves’ disease

Graves’ disease (GD) is the most common cause of thyrotoxicosis among children, characterized by stimulating autoantibodies against the thyrotropin receptor. In the pediatric population, GD is often more aggressive than in adults, with spontaneous remission rates after standard antithyroid drug therapy rarely exceeding 30% after 2 years of treatment. Radioactive iodine (RAI) therapy offers a minimally invasive, definitive solution by inducing permanent thyroid ablation through beta-particle-mediated follicular destruction. This review explores the timing of definitive therapy, the radiobiological mechanisms of iodine-131, and the comparative efficacy of RAI versus total thyroidectomy. Drawing on the 2016 American Thyroid Association and 2022 European Thyroid Association consensus guidelines, the analysis emphasizes the shift toward high-dose ablative strategies to ensure treatment success and minimize the theoretical risks of sublethal radiation exposure. Long-term safety data regarding secondary malignancies, reproductive health, and orbitopathy are scrutinized through recent evidence, confirming the relative safety of RAI in children over 10 years of age.