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Predictors of early remission of hyperthyroidism in children
1Department of Pediatrics, University of California, Davis School of Medicine, Sacramento 95817, USA.
Insights
Children with Graves' disease who achieve early remission from hyperthyroidism are older and have higher BMI SD scores and smaller goiters. These factors, along with goiter size, predict successful early remission in pediatric hyperthyroidism.
Area of Science:
- Pediatric Endocrinology
- Thyroidology
- Internal Medicine
Background:
- Hyperthyroidism in children, particularly Graves' disease, often necessitates prolonged antithyroid drug treatment.
- Long-term patient compliance with medication regimens for pediatric hyperthyroidism presents significant challenges.
- Identifying predictors of early remission is crucial for optimizing treatment strategies and patient management.
Purpose of the Study:
- To identify clinical and laboratory features that predict early remission in pediatric patients with Graves' disease.
- To compare characteristics of patients achieving remission within two years versus those requiring longer treatment.
- To determine independent predictors of early remission using statistical analysis.
Main Methods:
- Retrospective review of 191 pediatric patients (<19 years) diagnosed with Graves' disease.
- Comparison of patients achieving remission within 2 years (n=27) against those not in remission after >2 years (n=79).
- Stepwise multiple logistic regression analysis of variables measurable at diagnosis and associated with early remission (P < 0.05).
Main Results:
- Patients achieving early remission were older (12.5 vs. 10.9 years), had higher BMI SD scores (-0.03 vs. -0.60), and smaller goiters (60% vs. 83%).
- Lower heart rates, lower platelet counts, lower serum T4/T3 concentrations, and lower likelihood of positive thyroid stimulating immunoglobulins were associated with early remission.
- Body Mass Index (BMI) SD score and goiter size emerged as independent predictors of early remission (P < 0.05).
Conclusions:
- BMI SD score and goiter size are significant independent predictors of early remission in pediatric Graves' disease.
- A combination of higher BMI SD score and smaller goiter size strongly predicts early remission (86% success rate).
- Predictive algorithms using BMI SD score and goiter size can aid in patient counseling and therapeutic decision-making for pediatric hyperthyroidism.
Abstract:
Children with hyperthyroidism often require prolonged courses of antithyroid medication to achieve remission, and long-term compliance is problematic. To determine which clinical and laboratory features predict early remission, we reviewed the records of 191 patients less than 19 yr old with Graves' disease. We compared patients achieving remission within 2 yr (group 1, n = 27) with those who completed more than 2 yr of medical therapy but did not achieve a remission (group 2, n = 79). Patients who were in neither of the above categories (n = 85) were excluded from the statistical analysis. Variables that were measurable at the time of diagnosis, recorded in more than 50% of the study population and associated with early remission in the univariate analysis (P < or = 0.05), were entered into a stepwise multiple logistic regression analysis. Variables retaining a significant association with early remission (P < 0.05) were considered independent predictors of early remission. Patients achieving early remission were older (mean, 12.5 vs. 10.9 yr, P = 0.039) and had higher body mass indexes (BMI, 19.0 vs. 16.6, P = 0.002), higher BMI SD scores (-0.03 vs. -0.60, P = 0.004), lower heart rates (110 vs. 121, P = 0.023), smaller goiters (group 1: 60% with moderate/large goiter; group 2: 83%, P = 0.050), lower platelet counts (272 vs. 339 K/microL, P = 0.006), lower serum T4 and T3 concentrations at presentation (T4: 18.3 vs. 22.5 microg/dL, P = 0.015; T3: 439 vs. 613 ng/dL, P = 0.008), and were less likely to have a positive test for thyroid stimulating Igs (group 1: 50% vs. group 2: 93%, P = 0.008). Regression analysis identified BMI SD score and goiter size as independent predictors of early remission (P < 0.05). Eighty-six percent of patients with BMI SD score above -0.5 SD and minimal/small goiters achieved early remission, compared with 13% of those with BMI SD score below -0.5 SD and moderate/large goiters. We conclude that, of multiple clinical and laboratory variables associated with early remission, BMI SD score and goiter size are independent predictors. Algorithms employing these two variables can be used to facilitate counseling of patients and expedite therapeutic decisions.