Background: Management options are limited for the treatment of Graves' disease (GD) in children and adolescents. Antithyroid drugs (ATDs) remain the first-line therapy in patients with GD, despite a high relapse rate. We investigated the clinical characteristics, treatment, the outcome, and predictors of a remission of children and adolescents with GD at a single center.
Methods: We retrospectively reviewed the medical charts of patients with GD diagnosed before 19 years old at Samsung Medical Center over a 7-year period (May 2011 to June 2018). Diagnostic criteria included clinical signs suggestive of GD, elevated free T4 and total T3, suppressed TSH, and positive thyroid receptor antibodies. Remission was defined as maintenance of euthyroid status for more than 6 months after discontinuing ATD.
Results: A total of 107 children and adolescents with GD were included in this study. Their median age (±standard deviation) at diagnosis was 13.5 years (range: 2.718.7 years), and 88 patients were females. All patients started to receive treatment with ATD at the time of diagnosis. Of the 107 patients, 23 patients (21.5%) achieved a remission, 78 patients (73.8%) continued to take ATD, 4 patients (3.7%) underwent surgery, and 2 patients (1.9%) underwent radioactive iodine (RAI) therapy. The median time to relapse after discontinuation after ATD was 4.0 months (range: 1.072.0 months) and the median time to remission in 23 patients who achieved a remission with ATD treatment was 28.2 months (range: 1.294.6 months). The cumulative remission rate was 5.2%, 23.3% and 37.0% within 1 year, 3 year and 5 year, respectively. Of the 107 patients treated with methimazole (MMZ), 10 patients experienced mild adverse reactions (AEs), and one patient experienced severe AEs. Higher serological titer of TSH-receptor-Ab at diagnosis was associated with lower remission rates (p=0.017).
Conclusion: Most children and adolescents with GD reach to euthyroid status with ATD treatment, however, more than 40% of patients who have attempted to discontinue ATD experienced one or more relapses. The overall incidences of AEs associated with MMZ were 9.3 %, and most of them were mild. Higher serological titer of TSH-receptor-Ab at diagnosis is considered as a predictor of lower remission rates. Long-term ATD treatment is a useful treatment option for most children and adolescents, however, other treatment options.should be carefully considered in rare cases.
Keywords: Graves' disease, hyperthyroidism, Antithyroid drugs, Predictors of remission
19 - 21 Sep 2019
European Society for Paediatric Endocrinology