Background: The approach to clinical management of Graves disease (GD) is debatable.
Objective: This study aimed to identify predictors of remission in pediatric GD.
Methods: A longitudinal study of 36 children and adolescents with Graves disease followed from 1997 to 2017 at a single pediatric tertiary hospital was performed. Clinical and biochemical parameters, including comorbidities, treatment with anti-thyroid drugs (ATD) or definitive therapy (radioiodine (RIT) and thyroidectomy), and remission as the main outcome were collected. We performed a multivariable logistic regression analyses to identify likely predictors of remission, and a Kaplan-Meier survival curve to compare outcomes between groups.
Results: Among patients, most were female, in late puberty, with exuberant symptoms at onset. Eleven also suffered from Down syndrome (DS). Thirty-four patients (94%) started on methimazole from disease onset, and 25 (69%) received it as only therapy, with a mean duration of 2.7±1.8 years. Six crossed to RIT and three underwent thyroidectomy; no DS patient received definitive therapy. Remission was higher in DS patients (45% vs 25%, P=0.24), but afterwards (3.9±2.5 vs 2.3±1.4 years, P<0.05); no significance in relapsing (20% vs 15%). Females were less likely to reach remission (P<0.05); serum free T4 at onset was higher (P<0.05) in patients who required definitive therapy. Thyroid-stimulating immunoglobulin (TSI) values normalized in exclusively ATD therapy, especially from two years on (P<0.05).
Conclusions: 1) Males were more likely to achieve remission; 2) TSI values may normalize in Graves disease, notably from the second year of treatment; 3) Children with Down syndrome may benefit with conservative management in GD. Larger prospective multi-centered studies should confirm these findings.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology