BACKGROUND: Remission rates with antithyroid drugs (ATDs) in pediatric Graves' disease (GD) are low. Very few studies report long-term follow-up of GD especially into adulthood. OBJECTIVES: We studied long-term outcomes of pediatric onset GD, including a follow-up into adulthood and factors associated with need for definitive therapy. METHODS: Sixty-five patients (57 females) with GD, with onset <18 years (median 13, range, 3.5-17) and duration ≥2 years (median 7; range, 2-22) since diagnosis, were included. Medical records were reviewed, and current details were recorded in a questionnaire by telephonic interview. RESULTS: All patients were initially treated with ATDs. Fifty-three patients were treated for ≥2 years. Amongst these, outcomes included relapse after initial remission (n=38), failure of remission (n=8) and long-term remission, defined as remission lasting ≥4 years (n=6). One patient had carbimazole and surgery but died of hepato-renal failure secondary to systemic vasculitis. A total of 44/65 patients were managed with definitive treatment. Those needing definitive treatment had higher mean free T4 (54.6±23.7 vs. 39.5±20.5 pmol/L, p=0.02) and thyrotropin receptor antibody (TRAB) titers (34.1±19.3 vs. 13.8±9.9 IU/L p<0.0001). Long-term sequelae included need for thyroxine replacement (n=42, 64.6%), persistent goiter (12/62, 19.3%) and persistent ophthalmopathy (19/40, 47.5%). CONCLUSIONS: Long-term remission rates of pediatric onset GD with ATDs are very low, especially with longer follow-up. Higher pretreatment free T4 and high TRAB titers predict need for definitive treatment.
BACKGROUND: Remission rates with antithyroid drugs (ATDs) in pediatric Graves' disease (GD) are low. Very few studies report long-term follow-up of GD especially into adulthood. OBJECTIVES: We studied long-term outcomes of pediatric onset GD, including a follow-up into adulthood and factors associated with need for definitive therapy. METHODS: Sixty-five patients (57 females) with GD, with onset <18 years (median 13, range, 3.5-17) and duration ≥2 years (median 7; range, 2-22) since diagnosis, were included. Medical records were reviewed, and current details were recorded in a questionnaire by telephonic interview. RESULTS: All patients were initially treated with ATDs. Fifty-three patients were treated for ≥2 years. Amongst these, outcomes included relapse after initial remission (n=38), failure of remission (n=8) and long-term remission, defined as remission lasting ≥4 years (n=6). One patient had carbimazole and surgery but died of hepato-renal failure secondary to systemic vasculitis. A total of 44/65 patients were managed with definitive treatment. Those needing definitive treatment had higher mean free T4 (54.6±23.7 vs. 39.5±20.5 pmol/L, p=0.02) and thyrotropin receptor antibody (TRAB) titers (34.1±19.3 vs. 13.8±9.9 IU/L p<0.0001). Long-term sequelae included need for thyroxine replacement (n=42, 64.6%), persistent goiter (12/62, 19.3%) and persistent ophthalmopathy (19/40, 47.5%). CONCLUSIONS: Long-term remission rates of pediatric onset GD with ATDs are very low, especially with longer follow-up. Higher pretreatment free T4 and high TRAB titers predict need for definitive treatment.
Authors: Maria Rodanaki; Maria Lodefalk; Katharina Forssell; Carl-Göran Arvidsson; Maria Forssberg; Jan Åman Journal: Horm Res Paediatr Date: 2019-05-16 Impact factor: 2.852
Authors: Cláudia Patraquim; Vera Fernandes; Sofia Martins; Ana Antunes; Olinda Marques; José Luís Carvalho; Jorge Correia-Pinto; Carla Meireles; Ana Margarida Ferreira Journal: Case Rep Pediatr Date: 2017-01-31
Authors: Christiaan F Mooij; Timothy D Cheetham; Frederik A Verburg; Anja Eckstein; Simon H Pearce; Juliane Léger; A S Paul van Trotsenburg Journal: Eur Thyroid J Date: 2022-01-01