Review of the outcome of management of Graves' disease in children and adolescents.

OBJECTIVE: To review our recent experience in the management of paediatric Graves' disease, the leading cause of hyperthyroidism in childhood, in view of ongoing international debate regarding therapy.
METHODOLOGY: Retrospective medical record review of patients with Graves' disease, treated between 1985 and 1999, at the Royal Children's Hospital, Melbourne.
RESULTS: Forty patients, aged at diagnosis between 2.9 and 17.6 years (median age 11 years; 31 females), were treated. Thirty-three patients received either definitive therapy or at least 24 months medical therapy and follow up at the time of the study. Six patients experienced successful remission upon withdrawal of medication (median medication duration 3.2 years; four females; median follow up 4.1 years). Children successfully achieving remission were younger at presentation than those requiring surgery (9.5 vs 12.9 years, respectively; P = 0.01). Ten patients were treated surgically, leaving 4-6 g residual thyroid tissue. Surgical indications included failed initial medical therapy, relapse after medication cessation, non-compliance and significant medication side effects. During a median follow up of 1.7 years (range 0.2-5 years), three of 10 patients have subsequently relapsed and four of 10 patients are receiving postoperative thyroxine replacement. Transient hypocalcaemia occurred in five patients and temporary recurrent laryngeal nerve palsy occurred in two patients.
CONCLUSIONS: Fewer than 20% of children experienced successful sustained remission at median follow up of 3.2 years. Medication remains a well-tolerated therapeutic option. Surgery is a reasonable alternative when there are specific indications. In order to decrease the likelihood of surgical relapse, less than 4 g thyroid tissue should be left postoperatively.