ESPE Abstracts

Background/purpose: Graves’ disease (GD) is an autoimmune disorder characterized by hyperthyroidism, diffuse goiter, and/or ophthalmopathy that is caused by the activation of the thyroid-stimulating hormone (TSH) receptor by thyrotropin receptor antibodies (TRAb). GD is the most common cause of thyrotoxicosis in children and adolescents, accounting for 10-15% of all thyroid illness in children and adolescents. The treatment of GD in children and adolescents differs by country and is influenced by local traditions and resources, patient age, patient and parent preferences, and illness severity. This is a study of 195 children and adolescents with GD who were treated in a single center in Korea.

Methods: This study included children and adolescents with GD diagnosed before 19 years of age for twenty years. The diagnosis of GD was based on the presence of typical clinical features (tachycardia, tremor, exophthalmos, goiter, etc.), high levels of free thyroxine (FT4), suppressed thyroid-stimulating hormone, and a positive titer of thyrotropin receptor antibodies. After ceasing antithyroid medication, remission was defined as maintaining euthyroid condition for more than six months

Results: A total of 195 patients with GD were included in this study. The mean age at diagnosis was 12.9 ± 3.2 years, and 162 patients (83.1%) were female and 33 (16.9%) were male. Among all 195 patients, eight (4.1%) underwent definite treatment. The mean duration of follow-up and ATD treatment were 5.9 ± 3.8 years and 4.7 ± 3.4 years, respectively. FT4 level at diagnosis was higher in the non-remission group than in the remission group (5.0 ± 1.9 vs. 3.9 ± 1.5 ng/dl, P=0.002). FT4 level at diagnosis (P=0.001) was predicting factors for remission. Methimazole (MMI)-related adverse events (AEs) occurred in 11.3% of patients. Of a total of 26 AEs, 22(84.6%) occurred within the first three months

Conclusions: In this study, the cumulative remission rate increased according to the ATD treatment duration. Even with long-term treatment, fatal side effects were uncommon. As a result, in children and adolescents with GD, long-term MMI therapy with careful monitoring of drug-related AEs is a beneficial treatment option before definitive treatment.