Hyperthyroidism in Children Treated with Long Term Medical Therapy: Twenty-Five Percent Remission Every Two Years*

Lippe, Barbara M.; Landaw, Elliot M.; Kaplan, Solomon A.

doi:10.1210/jcem-64-6-1241

Cited by 173 publications

(114 citation statements)

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“…The risk of new hyperthyroidism was considerably higher in patients who were TRAbpositive at the end of medical therapy, but the initial TRAb values and the fall in TRAb during therapy overlapped between patients who became hyperthyroid and those who remained euthyroid. In patients who do not accept the risk of new hyperthyroidism after the stop of medication, prolonged medical therapy may be useful (28)(29)(30)(31). This should be balanced against the risk of drug side effects (32).…”

Section: Discussionmentioning

confidence: 99%

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Laurberg

Wallin²,

Tallstedt³

et al. 2008

European Journal of Endocrinology

364

231

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Introduction: Autoimmunity against the TSH receptor is a key pathogenic element in Graves' disease. The autoimmune aberration may be modified by therapy of the hyperthyroidism. Objective: To compare the effects of the common types of therapy for Graves' hyperthyroidism on TSHreceptor autoimmunity. Methods: Patients with newly diagnosed Graves' hyperthyroidism aged 20-55 years were randomized to medical therapy, thyroid surgery, or radioiodine therapy (radioiodine was only given to patients R35 years of age). L-thyroxine (L-T 4 ) was added to therapy as appropriate to keep patients euthyroid. Anti-thyroid drugs were withdrawn after 18 months of therapy. TSH-receptor antibodies (TRAb) in serum were measured before and for 5 years after the initiation of therapy. Results: Medical therapy (nZ48) and surgery (nZ47) were followed by a gradual decrease in TRAb in serum, with the disappearance of TRAb in 70-80% of the patients after 18 months. Radioiodine therapy (nZ36) led to a 1-year long worsening of autoimmunity against the TSH receptor, and the number of patients entering remission of TSH-receptor autoimmunity with the disappearance of TRAb from serum during the following years was considerably lower than with the other types of therapy. Conclusion: The majority of patients with Graves' disease gradually enter remission of TSH-receptor autoimmunity during medical or after surgical therapy, with no difference between the types of therapy. Remission of TSH-receptor autoimmunity after radioiodine therapy is less common.

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Section: Discussionmentioning

confidence: 99%

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Laurberg

Wallin²,

Tallstedt³

et al. 2008

European Journal of Endocrinology

364

231

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“…Based on published reports describing outcomes for children treated with antithyroid medications for Graves' disease, up to 10 years ago, PTU was more widely used than MMI [11–13]. More recent data however, suggest that two thirds of children in the United States treated with antithyroid medications are now being treated with MMI, and one-third are treated with PTU [4].…”

Section: Discussionmentioning

confidence: 99%

Adverse Events Associated with Methimazole Therapy of Graves' Disease in Children

Rivkees¹,

Stephenson²,

Dinauer³

2010

International Journal of Pediatric Endocrinology

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Objective. Graves' disease is the most common cause of hyperthyroidism in the pediatric population. Antithyroid medications used in children and adults include propylthiouracil (PTU) and methimazole (MMI). At our center we have routinely used MMI for Graves' disease therapy. Our goals are to provide insights into adverse events that can be associated with MMI use. Methods. We reviewed the adverse events associated with MMI use in our last one hundred consecutive pediatric patients treated with this medication. Results. The range in the patient age was 3.5 to 18 years. The patients were treated with an average daily dose of MMI of 0.3±0.2 mg/kg/day. Adverse events attributed to the use of the medication were seen in 19 patients at 17±7 weeks of therapy. The most common side effects included pruritus and hives, which were seen in 8 patients. Three patients developed diffuse arthralgia and joint pain. Two patients developed neutropenia. Three patients developed Stevens-Johnson syndrome, requiring hospitalization in 1 child. Cholestatic jaundice was observed in 1 patient. No specific risk-factors for the development of adverse events were identified. Conclusions. MMI use in children is associated with a low but real risk of minor and major side effects.

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“…To minimize the risk of side effects, the lowest possible dose of the drug should be used. Several investigators have reported that such therapy may prevent relapse of overt Graves' disease (17)(18)(19)(20). One mechanism behind such a protective effect of low dose MMI therapy may be a decrease in the risk of reactivation of the vicious cycle illustrated in Figure 2.…”

mentioning

confidence: 99%

Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

Laurberg

2006

eur j endocrinol

123

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Therapy of Graves' hyperthyroidism with thionamide anti-thyroid drugs is accompanied by a gradual remission of the autoimmune aberration in the majority of patients. The most likely mechanism behind this remission has been considered to be a direct immunosuppressive effect of thionamide drugs. However, a number of findings in clinical studies of patients with Graves' disease indicate that remission is probably not caused by a special effect of thionamide drugs. Many studies have shown that remission is linked to restoration of the euthyroid state, and that it is independent of drug dose and type. Moreover, similar remission is observed when patients become euthyroid after thyroid surgery. In an explanatory model described, it is assumed that the autoimmune aberration of Graves' disease is often basically quit mild and self-limiting. Patients may become ill by the running of a vicious cycle of hyperthyroidism worsening the autoimmunity, and autoimmunity worsening the hyperthyroidism. Once patients are made euthyroid by one or the other drug or by thyroid surgery, the majority of patients will gradually enter remission of the disease. The conclusion that remission is associated with restoration of the euthyroid state, and that it is not a special drug effect, highlights the importance of making and keeping patients with Graves' disease euthyroid. European Journal of Endocrinology 155 783-786

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Hyperthyroidism in Children Treated with Long Term Medical Therapy: Twenty-Five Percent Remission Every Two Years*

Cited by 173 publications

References 0 publications

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

TSH-receptor autoimmunity in Graves' disease after therapy with anti-thyroid drugs, surgery, or radioiodine: a 5-year prospective randomized study

Adverse Events Associated with Methimazole Therapy of Graves' Disease in Children

Remission of Graves’ disease during anti-thyroid drug therapy. Time to reconsider the mechanism?

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