Background: In 2011, ATA and AACE published Guidelines on pediatric Graves disease (GD) treatment. Nevertheless it is still a controversy.
Objective and hypotheses: SPEDP conducted the first nationwide questionnaire survey among all the Endocrinologists and Pediatricians in the Portuguese Public Health System Hospitals about pediatric GD treatment in order to know the reality in our country.
Method: SPEDP designed and distributed a questionnaire to all hospitals with pediatric endocrinology, to include all GD patients under 18 at diagnosis, and a minimum of 6 months follow-up, and a retrospective assessment of patients records was performed from May to August 2013.
Results: 67 out of 87 hospitals answered, only 25 had pediatric GD patients: 152 patients were identified, median age at diagnosis was 11.7 years (318), 76% females. All were initially treated with antithyroid drug (ATD) (median treatment duration 32.3 months): 69.1% tiamazol (TMZ) and 30.9% propylthiouracil (PTU), median initial dose 0.38 and 3.74 mg/kg respectively. After 2011, TMZ was used in 95% patients. Only minor side effects were found. Evolution: 39.4% (60) patients keep on ATD and 60.6% (92) finished first course treatment; 25.6% (39) remitted and remain euthyroid; 17.1% (26) relapsed after remission second therapy: surgery=two patients, 131-iodine=14, ATD=10; in 17.7% (27) the disease persisted and undergone definitive therapy surgery (13), 131-I (5) No significant predictors of remission like age, duration of initial treatment, ATS, initial TRABs levels were identified but patients with persistent disease had higher TRABs.
Conclusion: ATD therapy was the first choice for our pediatric GD population; despite a long treatment duration only 25% patients achieved long term remission; definitive therapy was a second choice in few patients (22.4%) and more frequent in recent years. According to the recent literature this results reflect a tendency for changing pediatric GD therapy.
20 - 22 Sep 2014
European Society for Paediatric Endocrinology