Graves' disease in childhood: advances in management with antithyroid drug therapy

Graves' disease is the most common cause of hyperthyroidism in children. Antithyroid drug (ATD) treatment is recommended as the initial treatment, leading to a marked improvement in most symptoms within 1 month of treatment initiation. Remission is achieved in 30% of children after a first course of ATD. Alternative treatments, such as radioactive iodine or thyroidectomy, are considered in cases of relapse, lack of compliance or ATD toxicity. The risk of relapse after a first course of ATD treatment for a median period of 2 years has been shown to be higher in patients with severe biochemical hyperthyroidism at diagnosis, young children and patients of non-Caucasian origin. Relapse risk decreases with the duration of the first course of ATD treatment, highlighting the positive impact of a long period of primary ATD treatment on outcome. The identification of predictive factors has made it possible to stratify patients according to the risk of relapse after ATD treatment, leading to improvements in patient management by facilitating the identification of patients requiring long-term ATD or early alternative therapy. Long-term careful follow-up is needed to determine the efficacy of disease management during childhood.