ESPE Abstracts

Introduction: Graves’ Disease (GD) is autoimmune hyperthyroidism occurring mostly in adolescent girls. The main pathogenic role of the disease is attributed to TSH receptor antibodies (TRAb), which stimulate the thyroid gland to increase the production of the most active thyroid hormone- triiodothyronine (T3). High levels of TRAb and a large goitre size are commonly known as poor prognostic factors for the disease and are used to predict relapse.

The aim: The purpose of our study was to check parameters that affect remission in GD.

Materials and Methods: 51 patients with GD were analyzed. The data were retrospectively retrieved from the hospital’s records consisting of patients’ sex, age, level of Anti- Thyroid peroxidase (TPO), TRAb, fT3, fT4 and thyroid volume on ultrasonography.

Results: The group was predominated by girls (25 % boys, 75 % girls). The mean age was 13.2 (min:4.1-max:17.3). Goitre was observed in 44 (%86) patients. Thyroid-associated orbitopathy (TAO) was observed in 56% of the participants. Twelve patients (23 %) are in remission and three relapsed (25%). Relapse occurred after a median of a 7 (±2.1 months) follow-up and remission time is shorter than no relapse (P<0.05). Anti TPO was statistically significantly higher in those who were in remission (P<0.05). Sex, age, level of TRAb, pubertal status, TAO, fT3, fT4, fT3:fT4 ratio, thyroid volume and T3-predominant GD concomitant use were not useful predictive factors for remission and relapse. The time to remission in prepubertal children was found to be statistically significantly longer than in pubertal children.

Conclusions: Our remission rate of GD has substantially similar data and studies. Patients with GD exhibiting large thyroids, high TRAb levels and elevated FT3/FT4 ratios are related to poor prognostic factors. Furthermore, in patients with large thyroids, TAO is demonstrated higher rates of recurrence. Positive correlations between Anti-TPO levels (Poor predictors of GD) may confirm a prognostic factor for GD severity. Remission in a short time (approximately in the first 7 months) is associated with relapse. The FT3/FT4 ratio is a new useful index for differential diagnosis of thyrotoxicosis but unreliable for predicting remission and relapse. The probability of remission in childhood Graves' disease is very low. It is still controversial what the most appropriate treatment method is in children and how long antithyroid drug treatment should be continued to achieve remission.