ESPE Abstracts (2015) 84 P-3-1176

Graves' Disease in Childhood and Adolescence: Clinical Manifestations, Adverse Effects, and Predictive Factors for Response to Antithyroid Drugs

Noelia Vanesa Dujovne, Gustavo Dratler, Fabián Pitoia, Laura Felipe, Victor Ayarzabal, Ianina Soria, Malena Berger, Alicia Belgorosky & Viviana Herzovich

Hospital de Pediatría Garrahan, Buenos Aires, Argentina

Background: Antithyroid drugs (ATD) are recommended as the initial treatment in Graves disease in childhood and adolescence. Identification of predictive factors might lead to improve patient management by facilitating the identification of patients requiring long-term ATD or early alternative therapy.

Objective and hypotheses: To assess the prevalence of signs and symptoms of hyperthyroidism in childhood and adolescence, to evaluate the rates of adverse events after medical treatment and to determine prognostic factors for the response to pharmacological treatment.

Method: We performed a retrospective, descriptive study. We evaluated 157 patients, mean age of 10.78±3.17 years, who were seen between September 2005 and May 2012 at Hospital J. P. Garrahan.

Results: The most common symptoms were: tremor (79%), weight loss (70%), tachycardia (70%), attention deficit (49%), and exophthalmos (44.6%), goiter more than three times the normal size defined by palpation (35%), diarrhea (21%), fever (10.8%), and menstrual irregularities (28%). Three to five symptoms were simultaneously found in 64% of cases. At least one associated disorder was found in 29%, being the most frequent, Down syndrome (12.7%). Adverse effects generated by anti-thyroid medication were observed in 29 patients (18.5%). Hepatitis was seen in 8.3%, hematological disorders in 7%, and arthritis in 6.4%. Only five of 29 cases (18.5%) had more than one adverse effect. Overall, 69% (n: 109) did not respond to drug treatment over a time lapse of 4 years after the first visit. Logistic regression model of factors for poor response to medical treatment were as follows: Age at diagnosis <10 years (P<0,01), a large goiter (P<0,01), and high initial T3 (>6.8 ng/ml), fT4 (>5.24 ng/dl), and TBII (>70.5%) levels (P<0.0001).

Conclusion: In young patients with a large goiter and high serum T3 and TBII levels, early alternative therapy instead of ATD should be considered.