ESPE Abstracts

Objective: To describe a cohort with paediatric Graves disease followed between 2012 and 2022 at King’s College Hospital, London.

Materials and Methods: Retrospective study of 36 patients treated with block and replace regimen of anti-thyroid drugs with a median (range) follow up of 4.25 (1.1-10.8) years. Demographic, clinical, biochemical and treatment data were collected from clinical records. Predictive factors for outcome (age, sex, free thyroxine and tri-iodothyronine concentrations at presentation, duration of treatment and TRabs concentrations at end of treatment) were analysed with Mann Whitney test for continuous variables and Fisher’s exact test for categorical variables.

Results: Median (range) age at diagnosis was 13.1 (5-17.1) years. Seven patients were <10 years of age. Majority were females (29; 81%). Free thyroxine and free tri-iodothyronine concentrations ranged between 21.5 and >100pmol/L (median-75 pmol/L) and 7.2 and >50 pmol/L (median-30pmol/L) respectively. Thyroid stimulating hormone (TSH) was undetectable (<0.05 mIU/L) in all patients. When measured at diagnosis, TSH receptor antibodies (TRAbs) were elevated in 96% patients. 79% of patients with elevated TRAbs also had elevated anti-TPO antibodies. There was a positive correlation between TRAbs concentration and free thyroxine concentration (r= 0.76; P <0.0001) as well as between TRAbs concentration and free tri-iodothyronine concentrations (r= 0.53; P= 0.0079). Median (range) carbimazole starting dose was 0.66mg/kg (0.19 – 1.38). Three patients moved out of area and one patient opted for thyroidectomy during primary course of anti-thyroid treatment. Weight z-scores at 6 months and 12 months were significantly higher than at diagnosis (1.4±1.1 vs 0.99±1.1; P=0.0005, 1.3±1.1 vs 0.99±1.1; P=0.0354). In the twenty-three patients who have completed primary course of treatment with anti-thyroid drugs, the median duration of treatment was 30.5 [19-52] months. Of these, seven patients remain in remission and sixteen patients relapsed after a median (range) period of 6.5 months (0-46 months). Patients who relapsed were significantly younger than those who did not (Median ± Interquartile range 12.1±5.3 vs 15.2±4 years P= 0.0143). Sex, free thyroxine and tri-iodothyronine concentrations at presentation, duration of treatment and TRabs concentrations at end of treatment were not predictors for remission in our cohort (P > 0.05).

Conclusion: Remission rate was 30% in our cohort after a median 2.5 years of anti-thyroid treatment, with age at presentation as the only predictive factor for remission. Excessive weight gain within 12 months of treatment is commonly seen in children treated for Graves’ disease.