Remission Predictors of Graves` Disease in Children

Abstract

Purpose : Antithyroid drug treatment is usually recommended as the initial treatment for children with Graves’ disease. However, achieving remission with medical therapy usually requires many years of treatment, the risk for adverse reactions is relatively high and relapse is common after discontinuation of medication. There is therefore a debate about how Graves’ disease should be treated in children. The aim of this study was to identify predictors of remission during 2 years from quitting of antithyroid drug.

Methods : We retrospectively studied children who had been treated for Graves’ disease with antithyroid medication. We compared the children who achieved remission after two years with those who had persistent disease, to determine the variables associated with remission.

Results : 41 patients were enrolled, of whom five (12.2%) achieved remission and the rest (87.8%) could not achieve remission until the last visit. There were no significant differences in T3, free T4, antimicrosomal antibody (AMA), or thyroid stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) between the two groups at presentation. However, the remission group had a significantly higher titer of TSH (P =0.04) and a significantly lower titer of antithyroglobulin antibody (ATA) (P=0.01) than the non-remission group at presentation. The non-remission group had higher ATA concentrations 3 months after treatment with antithyroid medication than the remission group did (P=0.02).

Conclusion : TSH and ATA concentrations at presentation can be used to stratify patients according to the likelihood of remission during 2 years from quitting of antithyroid drug.