Trends in Management and Outcomes of Pediatric Hyperthyroidism Over Two Decades

Area of Science:

• Pediatric Endocrinology
• Thyroidology
• Clinical Research

Background:

• Observed variations in pediatric hyperthyroidism (HT) and Graves' disease (GD) incidence, treatment, and outcomes over recent decades.
• Pediatric HT and GD management strategies and long-term results require updated evaluation.

Purpose of the Study:

• To evaluate trends in pediatric HT management and long-term outcomes over a 20-year period.
• To analyze changes in treatment modalities and their impact on remission and relapse rates.

Main Methods:

• Retrospective analysis of a large health maintenance organization's electronic database.
• Inclusion of children aged 2-18 diagnosed with HT between 2000-2019, treated with antithyroid drugs (ATDs) for ≥6 months, and followed up through 2024.
• Comparison of treatment approaches and outcomes between 2000-2009 and 2010-2019 cohorts.

Main Results:

• A decrease in initial methimazole dosage and reduced likelihood of definitive treatment in the later decade (2010-2019).
• Higher nonremission and relapse rates observed in children diagnosed in 2010-2019 compared to 2000-2009.
• Factors associated with later remission included younger age, positive antithyroid peroxidase antibodies, and higher baseline free thyroxine levels.

Conclusions:

• Pediatric HT management has shifted towards prolonged ATD therapy with decreased reliance on definitive treatments.
• This shift in practice is associated with increased relapse rates, highlighting significant clinical implications.
• Further research is needed to assess the long-term prognostic impact of evolving pediatric HT treatment strategies.