LAUSR

CLINICAL SCENARIO A 14yearold female attends the paediatric Emergency Department with noticeable palpitations, tremor and debilitating headache. On observations, she was found to have a heart rate of 112 bpm and a blood pressure of 149/56 mm Hg. She had presented 3 years prior and diagnosed with juvenile Graves’ hyperthyroidism and started on methimazole to achieve euthyroidism. Two months ago, she began a gradual reduction of her antithyroid medication. Her most recent thyroid function tests show a low Thyroid Stimulating Hormone (TSH) and a significantly raised free T3 and T4. You suspect recurrent Graves’ disease but are unsure what definitive treatment to achieve remission should be given. Her parents are reluctant to restart her antithyroid medication. They have read about radioiodine online and ask for your opinion on which treatment has the best evidence of achieving remission in the long term.