Introduction: Graves disease (GD), the main cause of hyperthyroidism in children, is caused by thyrotropin receptor stimulating autoantibodies (TRABs) that activate thyroid hormone synthesis, secretion and thyroid growth. Therapeutic options are anti-thyroid drugs (ATD), 131-I or thyroidectomy. This study reports the experience of a Tertiary Pediatric Endocrinology Unit.
Methods: Review of GD patients diagnosed from January/2001 to October/2017. Results were expressed as mean and standard-deviation, statistical significance at <0.05.
Results: 21 patients, 19 girls, 38% diagnosed in the last two years. At diagnosis, mean age was 11.94±3.50 years, 6 patients (28.6%) presented ophthalmopathy, FT4 and FT3 levels were increased 7.70-fold (035) and 2.13-fold (05.7); mean TRABs titer was 27.54-fold (0188) and normal in 2 patients. All patients had thyroid volumes above 97th percentile. Five patients (23.8%) presented thyroid disease family history and 3 (14.3%) had other auto-immune disease. All patients received ATD as first treatment: 23.8% (n=5) propylthiouracil (PTU) (before 2011), 71.4% (n=15) tiamazol (TMZ) and 1 carbimazole. Mean time treatment since diagnosis until TSH normalization was higher for PTU (6.5±0.71 (67); 4.39±2.94 months (0.8110.0) P=0.049). Time to thyroid hormones normalization was similar for both drugs (PTU 3±1.4 (24); TMZ 3.28±2.99 months (0.410) P=0.844). Both ATD had similar TRAbs titers when thyroid function normalized (P=0.199). No adverse effects were reported with TMZ. One PTU treated patient developed hepatitis. Mean treatment duration was: PTU 40.60±35.54 and TMZ 28.90±13.20 months, P=0.282; remission rate was 19%, similar for both ATD (P=0.217). After TSH normalization, ATD maintenance mean time was: PTU 20.5±2.1 and TMZ 24.51±14 months, P=0.323. A 2nd treatment was tried in 3 patients; 2 relapsed and were proposed for definitive treatment. Definitive treatment was used in 8 patients (38%), 131-I in 6 (28.6%), with no adverse reactions, and surgery (total/subtotal thyroidectomy) in 2 (9.5%). One patient needed a second 131-I dose. After surgery, 1 patient developed persistent hypoparathyroidism. Seven patients (33.3%) maintain ATD treatment (mean time 22.94±9.0 (1436) months); 2 finished ATD 2 months ago.
Conclusions: As recommended by 2011 international guidelines, TMZ was the first treatment. Despite a rapid achievement of euthyroidism, treatment duration was longer and only 19% patients entered remission. We found an increase in diagnosis in the last years that conditioned our results. Definitive therapy had a high rate of success without adverse effects.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology