Long-term outcomes of pediatric Graves’ disease

Jevalikar, Ganesh; Solis, Julieta; Zacharin, Margaret

doi:10.1515/jpem-2013-0342

Cited by 21 publications

(25 citation statements)

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“…The proportion of boys in this study does not differ significantly from the proportions found in previous studies [8, 10, 12, 18] and it did not change between the first and the second 10-year study periods.…”

Section: Discussioncontrasting

confidence: 67%

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

et al. 2019

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Background: We found an increase in the incidence rate (IR) of childhood thyrotoxicosis (CT) during the 1990s in central Sweden. The optimal treatment method for CT is a subject that is still debated upon. Objectives: To investigate whether the increase in IR of CT in Sweden persists and to study the treatment outcome. Method: Children <16 years of age diagnosed with CT during 2000–2009 and living in 1 of 5 counties in central Sweden were identified retrospectively using hospital registers. Data on clinical and biochemical characteristics and outcomes of treatment were collected from medical records. The corresponding data from 1990 to 1999 were pooled with the new data. Results: In total, 113 children were diagnosed with CT during 1990–2009 in the study area. The overall IR was 2.2/100,000 person-years (95% CI 1.2–2.5/100,000 person-years). The IR was significantly higher during 2000–2009 than during 1990–1999 (2.8/100,000 [2.2–3.6] vs. 1.6/100,000 person-years [1.2–2.2], p = 0.006). The increase was significant for both sexes. Seventy percent of the patients who completed the planned initial treatment with antithyroid drugs (ATDs) and were not lost to follow-up relapsed within 3 years. Boys tended to relapse earlier than girls (6.0 months after drug withdrawal [95% CI 1.9–10.0] vs. 12.0 months [95% CI 6.8–17.3], p = 0.074). Conclusions: The IR of CT is increasing in both girls and boys. Relapse rate after withdrawal of ATD treatment is 70%. Boys tend to relapse earlier than girls, and this needs to be further investigated.

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Section: Discussioncontrasting

confidence: 67%

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

et al. 2019

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“…Studies in adults and children have taught us that the initial severity and course of the disease are highly variable and that relapse rates are higher in children than that in adults, with remission occurring in 20-30% in children and 40-60% of adults after a first course of treatment lasting a median of 2 years (3,24,31,32,33,34,35,36,37,38,39). Relapse occurs within 6 months of the end of drug treatment in 75% of patients, whereas only 10% of patients present a relapse more than 18 months after the end of the treatment (36,40,41).…”

Section: Outcomementioning

confidence: 99%

“…They also tend to present the biases inherent to observational design, with most studies retrospective, with a limited number of patients enrolled, many of whom are lost to follow-up, and large amounts of missing data. The main pediatric cohort studies are summarized in Table 1 (3,27,31,32,33,34,35,36,37,38,39,40,49). The comparative effectiveness of treatment with ATD, as characterized by the remission rate (the definition of which differs between studies), varied from 11 to 49% with treatment most effective for the longer duration of treatment with ATD in two large independent cohorts, with no fatal side effects reported (27,40).…”

Section: Recent Findings From Studies In Childrenmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Léger

Carel

2017

European Journal of Endocrinology

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Graves' disease is an autoimmune disorder. It is the leading cause of hyperthyroidism, but is rare in children. Patients are initially managed with antithyroid drugs (ATDs), such as methimazole/carbimazole. A major disadvantage of treatment with ATD is the high risk of relapse, exceeding 70% of children treated for duration of 2 years, and the potential major side effects of the drug reported in exceptional cases. The major advantage of ATD treatment is that normal homeostasis of the hypothalamus-pituitary-thyroid axis may be restored, with periods of drug treatment followed by freedom from medical intervention achieved in approximately 40-50% of cases after prolonged treatment with ATD, for several years, in recent studies. Alternative ablative treatments such as radioactive iodine and, less frequently and mostly in cases of very high volume goiters or in children under the age of 5 years, thyroidectomy, performed by pediatric surgeons with extensive experience should be proposed in cases of noncompliance, intolerance to medical treatment or relapse after prolonged medical treatment. Ablative treatments are effective against hyperthyroidism, but they require the subsequent administration of levothyroxine throughout the patient's life. This review considers

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“…Персистенция тирео-токсикоза на фоне лечения тиреостатиками нередко приводит к развитию эндокринной офтальмопатии [4]. После прекращения терапии тиреостатиками реци див возникает у 10-90% (в среднем у 60-75%) пациентов, чаще всего рецидив тиреотоксикоза про-воцируется стрессом и беременностью, но может возникать идиопатически [7,8].…”

Section: актуальностьunclassified

Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

et al. 2017

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Диффузный токсический зоб (болезнь Грейвса) является наиболее частой причиной гипертиреоза у детей и подростков. Методами выбора в лечении являются терапия тиреостатиками, оперативное вмешательство, радиойодтерапия (РЙТ). Изучение эффективности и безопасности РЙТ тиреотоксикоза у детей и подростков является актуальной задачей. В настоящей статье мы суммировали результаты серии клинических наблюдений и проанализировали эффективность и безопасность РЙТ диффузного токсического зоба (ДТЗ) у детей и подростков. Мы наблюдали всего 25 пациентов в воз-расте от 11 до 17 лет (в среднем 14,8 года) с ДТЗ. Десяти пациентам в 2016 г. РЙТ (активности 550-920 мБк) была про-ведена в ФГБУ ЭНЦ. Период в этой подгруппе наблюдения -6-11 мес. Вторая подгруппа (15 пациентов) была пролече-на в радиологическом отделении города Нижнего Тагила (Свердловская область) в период с августа 2005 г. по сентябрь 2012 г. Период наблюдения составил от 3,5 до 11,5 лет (в среднем 8,54 ± 2,87 года). РЙТ была проведена без каких-либо осложнений, непосредственных или отдаленных. У двух пациентов, имевших признаки эндокринной офтальмопатии в неактивной фазе, не возникло ухудшения глазных симптомов после РЙТ. У 17 (68%) из 25 пациентов через 6 мес после РЙТ развился гипотиреоз. В одном случае -эутиреоз. В остальных 7 наблюдениях зарегистрирован рецидив тиреоток-сикоза. Подгруппы пациентов не различались по возрасту, соотношению по полу, объему щитовидной железы и титру антител к рецептору тиреотропного гормона, но отличались по величине лечебной активности 131 I (подгруппа ЭНЦ -550-920 МБк; подгруппа из Нижнего Тагила -168-400 МБк). При этом эффективность лечения значимо не отличалась (p = 0,99): 68 и 73% соответственно. Таким образом, РЙТ является эффективным, хорошо переносимым и безопасным методом лечения ДТЗ у детей и подростков. Необходимо продолжить исследование в более многочисленной выборке, при больших сроках наблюдения, а также совершенствовать эффективность РЙТ. Клю че вые сло ва: радиойодтерапия, диффузный токсический зоб, дети, подростки, эффективность, безопасность.There are three methods in treatment of Graves' disease in children and adolescents -antithyroid drugs, surgery and radioiodine therapy (RIT). However, treatment protocol of children and adolescents doesn't exist. In the present case series study we have evaluated the effectiveness and safety of RIT in children and adolescents. We have observed totally 25 patients in age 11-17 years old (mean 14.8 years) with Graves' disease. Ten patients were treated with RIT in Endocrinology Research Centre (Moscow) in 2016 year with activities 550-920 MBq. Follow-up period varied 6-11 months in this subgroup. The second subgroup (15 patients) was treated in radiology department in Nijniy Tagil rural hospital (Ural region) in the period 2005-2012 years. Follow-up period varied 3.5-11.5 years (mean 8.5 years). RIT was executed in all patients without any complications, direct or long-term. In two patients having endocrine ophtalmopathy in non-active phase it was no any signs of worsening in resul...

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Long-term outcomes of pediatric Graves’ disease

Abstract: Long-term remission rates of pediatric onset GD with ATDs are very low, especially with longer follow-up. Higher pretreatment free T4 and high TRAB titers predict need for definitive treatment.

Cited by 21 publications

References 10 publications

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden

MANAGEMENT OF ENDOCRINE DISEASE: Arguments for the prolonged use of antithyroid drugs in children with Graves’ disease

Efficacy and safety of radioiodine treatment of Graves’ disease in children and adolescents

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