Clinical utility of TRAb reduction in predicting remission in pediatric Graves' disease

Hyperthyroidism in childhood impairs quality of life, with Graves' disease (GD) being the predominant cause. Although most cases can be managed with antithyroid drugs (ATD), recurrence remains challenging due to its frequency and unpredictability. Although thyrotropin receptor antibody (TRAb) has been proposed as a potential biomarker for predicting recurrence, the details, including the cut-off value, remain to be elucidated. We retrospectively analyzed 41 children (aged 2-15 yr) with GD and initiated ATD between 2005 and 2024 at two centers. Patients were classified into two groups, remission (n = 8) or non-remission (n = 33) based on the duration of euthyroidism for ≥ 24 mo after ATD discontinuation. TRAb levels were measured at the commencement of the therapy and every 6 mo afterward up to 24 mo. TRAb reduction rates (TRR) were significantly greater in the remission group at 6, 18, and 24 mo after treatment initiation. Among these, the 24-mo ROC analysis of TRR yielded the highest predictive value with an optimal cut-point of 93.2% (sensitivity 81.5%, specificity 85.7%). We concluded that the TRR is a potential marker to predict the remission of pediatric GD. Serial monitoring of TRAb would help to optimize the timing of ATD discontinuation.