Graves' disease in children

Graves' disease is the most frequent cause of hyperthyroidism in children. It may occur at any time during childhood, but its frequency increases with age, peaking during adolescence. Antithyroid drugs (ATDs; methimazole or carbimazole) are usually recommended as the initial treatment and are generally well tolerated. The overall frequency of relapse is higher in children than in adults, with remission achieved in only 30% of children after a first course of treatment for about 2 years. More prolonged medical treatment may increase the remission rate to up to 50%. The identification of factors predictive of relapse, such as severe biochemical hyperthyroidism at diagnosis and the absence of other autoimmune conditions, has facilitated the identification of patients requiring long-term ATD treatment or alternative therapy. Alternative treatments (mostly radioactive iodine, rather than thyroidectomy) are considered in cases of relapse after an appropriate course of ATD, lack of compliance or ATD toxicity. Future research on the management of patients should focus on improving compliance with drug treatment through educational strategies, improving knowledge of the long-term effects of the various treatment options on thyroid gland morphology and function, potential morbidities, future pregnancies and quality of life. A better understanding of the physiopathology of this disorder should improve remission rates and patient management and lead to the identification of factors predicting the likelihood of remission.