Long-term outcomes of graves disease in children treated with anti-thyroid drugs

Abstract

Background: Graves disease (GD) is the most common cause of thyrotoxicosis in children and adolescents, accounting for 15% of all thyroid diseases during childhood. Anti-thyroid drugs (ATD) are recommended as the first-line treatment in children and adolescents. However, the remission rate is lower in children than in adults, and the optimal treatment duration and favorable factors associated with remission remain unknown. We aimed to investigate long-term outcomes of pediatric GD patients receiving ATD. Methods: We retrospectively reviewed medical charts of 396 GD subjects from 1985 to 2017 at MacKay Children's Hospital. Ninetyesix patients were excluded from the analyses, including 71 patients followed for less than one year, 6 patients who received radioactive therapy and 19 patients who received surgery. The remaining 300 patients initially treated with ATD and

Graves’ Disease in Fourteen Years Old Girl

“…Female is predominantly affected by this disease. Familial inheritance also reported in several cases [10]. In our case, the patient is female, age 14 years old.…”

“…The clinical manifestations of Grave's disease are varying in different age range [11]. Although presenting symptoms are similar to the adult population in many ways, children and adolescents may present with non-specific symptoms that can be overlooked or attributed to normal changes children go through, such as nervousness, fatigue, sleep disturbances, or behavioral and learning disorders [10,11]. In our case, the patient came with chief complain of palpable mass around the neck.…”

“…In most centers, the majority of children with grave's disease are initiated on antithyroid drugs with Radio Active Iodine (RAI) ablation and surgery being reserved for children who do not achieve sustained remission with anti-thyroid drugs. Anti-thyroid drugs (ATD) include methimazole and propylthiouracil (PTU) which reduce thyroid hormone synthesis [8,10,13]. In 2009, because of the unacceptably high rates of PTU-induced liver injury requiring liver transplant in children, the medication is no longer approved in the pediatric population.…”

“…Grave's disease during ATD treatment is related to thyroid binding inhibiting immunoglobulin, pre-treatment severity of hyperthyroidism, and time to normalization of serum T 3 and T 4 [10].…”

“…An older age, a greater body mass index (BMI) at diagnosis, a smaller goiter size, a greater initial dosage, and prolonged drug treatment are among the factors analyzed that correlate with a greater likelihood of remission. Therefore, children and adolescents usually undergo longer periods of drug treatment than adults, despite the absence of an evidence-based strategy for disease management [9,10].…”