ESPE Abstracts (2018) 89 P-P2-376

Long Term Monitoring of Graves Disease in Children and Adolescents: Single Center Experience

Selma Tunça, Özge Köprülüa, Hatice Ortaçb, Özlem Nalbantoğlua, Ceyhun Dizdarera, Korcan Demirc & Behzat Özkana


aDr. Behçet Uz Children’s Hospital, Clinic of Pediatric Endocrinology, İzmir, Turkey; bDicle University Faculty of Medicine Department of Bioistatistics, Diyarbakır, Turkey; cDokuz Eylül University Faculty of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey


Introduction: Antithyroid Drugs (ATD) are generally preferred at the onset of treatment with no consensus on the duration of ATD (propylthiouracil, methymasole) treatment Graves disease in children.

Objective: Examining the effectiveness of ATD treatment on children and adolescents and determining the risk factors of remission and relapse.

Method: A total of 45 cases with ages varying between 1–18 years diagnosed with Graves disease during 2003–2017 were included in this retrospective study. The average age of diagnosis was 12.5 years with a total of 36 female (80%) and 9 male patients. ATD treatment was started on all cases. While 22 cases were treated with methymasole (average starting dose 0.65±0.24 mg/kg/day), 23 cases were administered with propylthiouracil (PTU) treatment (average starting dose 3.88±1.37 mg/kg/day). In accordance with the 2009 FDA suggestion, treatment was changed to methymasole (MMI) for 5 cases who were undergoing PTU treatment. Whereas titration treatment was applied on 9 cases (20%), blockage-replacement treatment was preferred for 36 (80%) of the cases. ATD treatment was stopped for all cases undergoing medical treatment at the end of an average treatment period of 23.2±13.2 months (10–73 days).

Results: The cases were classified into 2 groups as remission and relapse groups. While remission was attained in 24 (53%) of the cases, relapse was observed in 21 (47%) cases. The average duration for initial treatment was 23.2±13.2 months (10–37 months). The period of time until the end of the initial treatment was longer in the remission group (26.91±16.18 months) in comparison with the relapse group (19.09±7.14 months) (P=0.01). The total ATD treatment duration was longer at a statistically significant level in the remission group (38.14±14.35 months) in comparison with the relapse group (26.95±16.13 months) (P=0.03). While ATD treatment was started again in 10 of the cases with relapse, remission was attained in 5 of these cases. Of the cases in which relapse was observed, 4 were subject to surgical treatment and 2 were subject to RAI treatment. Hypothyroidism developed in one case after surgical treatment and in 2 cases after RAI treatment.

Conclusion: Long-term initial ATD treatment until remission and long-term total ATD treatment were evaluated as a positive parameter for the Graves disease in children independent of age, gender and pubertal state.

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