Graves' disease in children: long-term outcomes of medical therapy

Area of Science:

• Pediatric Endocrinology
• Thyroid Disorders
• Graves' Disease Management

Background:

• Graves' disease in children presents limited treatment options and debated optimal management strategies.
• Understanding the characteristics and outcomes of pediatric Graves' disease is crucial for clinical decision-making.

Purpose of the Study:

• To describe the demographic and biochemical profiles of children diagnosed with Graves' disease.
• To evaluate the effectiveness and outcomes of different management strategies, including antithyroid drugs, radioactive iodine, and thyroidectomy.

Main Methods:

• Retrospective analysis of medical records from 2001-2011 at a tertiary pediatric hospital.
• Inclusion criteria: elevated free T4 and total T3, suppressed TSH, positive thyroid-stimulating immunoglobulin or receptor antibodies, or clinical signs.
• Treatment modalities included antithyroid drugs (ATD), radioactive iodine, or thyroidectomy; remission and relapse rates were primary outcomes.

Main Results:

• 291 children diagnosed with Graves' disease; 268 initiated ATD, 23 underwent ablation/thyroidectomy.
• Remission achieved in 21% of children on ATD; 28% of those in remission relapsed, typically within 16 months.
• Methimazole adverse reactions occurred in 21% of patients, generally mild (rash, arthralgias, elevated transaminases, neutropenia).

Conclusions:

• Antithyroid drugs (ATD) lead to remission in a minority of pediatric Graves' disease patients, but relapses are infrequent after achieving remission.
• Adverse reactions to methimazole are common but typically mild, suggesting ATD remain a viable treatment option.
• Gender and ethnicity did not significantly influence remission or relapse rates in this cohort.