Abstract
Background: Remission rates with antithyroid drugs (ATDs) in pediatric Graves’ disease (GD) are low. Very few studies report long-term follow-up of GD especially into adulthood.
Objectives: We studied long-term outcomes of pediatric onset GD, including a follow-up into adulthood and factors associated with need for definitive therapy.
Methods: Sixty-five patients (57 females) with GD, with onset <18 years (median 13, range, 3.5–17) and duration ≥2 years (median 7; range, 2–22) since diagnosis, were included. Medical records were reviewed, and current details were recorded in a questionnaire by telephonic interview.
Results: All patients were initially treated with ATDs. Fifty-three patients were treated for ≥2 years. Amongst these, outcomes included relapse after initial remission (n=38), failure of remission (n=8) and long-term remission, defined as remission lasting ≥4 years (n=6). One patient had carbimazole and surgery but died of hepato-renal failure secondary to systemic vasculitis. A total of 44/65 patients were managed with definitive treatment. Those needing definitive treatment had higher mean free T4 (54.6±23.7 vs. 39.5±20.5 pmol/L, p=0.02) and thyrotropin receptor antibody (TRAB) titers (34.1±19.3 vs. 13.8±9.9 IU/L p<0.0001). Long-term sequelae included need for thyroxine replacement (n=42, 64.6%), persistent goiter (12/62, 19.3%) and persistent ophthalmopathy (19/40, 47.5%).
Conclusions: 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.
Acknowledgments
The authors acknowledge Prof. Fergus Cameron for his contribution to the data.
Conflict of interest statement:
No author has any financial or conflict of interest in relation to this paper, and no financial support was received for the study.
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©2014 by De Gruyter
Articles in the same Issue
- Frontmatter
 - Highlight: Cushing syndrome
 - Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
 - Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
 - Cushing’s disease presenting as cholestatic hepatitis
 - How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
 - Review article
 - Subclinical hypothyroidism in childhood and adolescense
 - Original articles
 - Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
 - Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
 - Measures of pituitary gland and stalk: from neonate to adolescence
 - Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
 - Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
 - Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
 - A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
 - Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
 - Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
 - Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
 - Long-term outcomes of pediatric Graves’ disease
 - Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
 - Vitamin D, parathormone, and insulin resistance in children born large for gestational age
 - Prevalence of vitamin D deficiency in apparently healthy children in north India
 - Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
 - Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
 - Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
 - Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
 - Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
 - Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
 - The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
 - The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
 - Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
 - Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
 - Patient reports
 - Hereditary vitamin D rickets: a case series in a family
 - Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
 - Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
 - Acquired hypothyroidism due to iodine deficiency in an American child
 - Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
 - Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
 - Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
 - Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
 - Short communications
 - Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
 - Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
 - Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
 - Letter to the Editor
 - And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?
 
Articles in the same Issue
- Frontmatter
 - Highlight: Cushing syndrome
 - Fundamental principles of clinical and biochemical evaluation underlie the diagnosis and therapy of Cushing’s syndrome
 - Cushing syndrome secondary to CRH-producing Wilms tumor in a 6 year old
 - Cushing’s disease presenting as cholestatic hepatitis
 - How early can one diagnose Cushing’s disease? An early diagnosis in a case of prepubertal Cushing’s disease
 - Review article
 - Subclinical hypothyroidism in childhood and adolescense
 - Original articles
 - Energy substrate metabolism in pyruvate dehydrogenase complex deficiency
 - Chromosome 6q24 transient neonatal diabetes mellitus and protein sensitive hyperinsulinaemic hypoglycaemia
 - Measures of pituitary gland and stalk: from neonate to adolescence
 - Are preterm newborns who have relative hyperthyrotropinemia at increased risk of brain damage?
 - Pseudohypoparathyroidism vs. tricho-rhino-phalangeal syndrome: patient reclassification
 - Association of serum 25-hydroxyvitamin D with race/ethnicity and constitutive skin color in urban schoolchildren
 - A nonsense thyrotropin receptor gene mutation (R609X) is associated with congenital hypothyroidism and heart defects
 - Acanthosis nigricans, vitamin D, and insulin resistance in obese children and adolescents
 - Clinical characteristics and chromosome 11p15 imprinting analysis of Silver-Russell syndrome – a Chinese experience
 - Change in reference body mass index percentiles and deviation in overweight and obesity over 3 years in Turkish children and adolescents
 - Long-term outcomes of pediatric Graves’ disease
 - Accessibility of the reference center as a protective factor against ketoacidosis at the onset of diabetes in children
 - Vitamin D, parathormone, and insulin resistance in children born large for gestational age
 - Prevalence of vitamin D deficiency in apparently healthy children in north India
 - Prevalence of autoantibodies in type 1 diabetes patients and its association with the clinical presentation – UAE Eastern Region experience
 - Clinical and molecular studies related to bone metabolism in patients with congenital adrenal hyperplasia
 - Islet neogenesis-associated protein-related pentadecapeptide improves the function of allograft after islets transplantation
 - Anti-Mullerian hormone may be a useful adjunct in the diagnosis of polycystic ovary syndrome in nonobese adolescents
 - Early infant feeding practice and childhood obesity: the relation of breast-feeding and timing of solid food introduction with childhood obesity
 - Late onset X-linked adrenal hypoplasia congenita with hypogonadotropic hypgonadism due to a novel 4-bp deletion in exon 2 of NR0B1
 - The correlation between GnRH stimulation testing and obstetric ultrasonographic parameters in precocious puberty
 - The DATAC study: a new growth database. Description of the epidemiology, diagnosis and therapeutic attitude in a group of Spanish children with short stature
 - Concentrations of tumour necrosis factor-α and its soluble receptors in the serum of teenagers with atherosclerosis risk factors: obesity or obesity combined with hypertension
 - Are HDL levels lower in children with type 1 diabetes and concurrent celiac disease compared with children with type 1 diabetes only?
 - Patient reports
 - Hereditary vitamin D rickets: a case series in a family
 - Two heterozygous mutations of the AMH gene in a Japanese patient with persistent Müllerian duct syndrome
 - Two case reports of severe pediatric hyperosmolar hyperglycemia and diabetic ketoacidosis accompanied with rhabdomyolysis and acute renal failure
 - Acquired hypothyroidism due to iodine deficiency in an American child
 - Continuous subcutaneous IGF-1 therapy via insulin pump in a patient with Donohue syndrome
 - Amylase/creatinine clearance ratio in diabetic ketoacidosis: a case report
 - Worsening hypertriglyceridemia with oral contraceptive pills in an adolescent with HIV-associated lipodystrophy: a case report and review of the literature
 - Congenital hyperinsulinism in a newborn with a novel homozygous mutation (p.Q392H) in the ABCC8 gene
 - Short communications
 - Polyglandular autoimmune syndrome type I – a novel AIRE mutation in a North American patient
 - Post-hemorrhagic hydrocephalus and diabetes insipidus in preterm infants
 - Two novel mutations in acid α-glucosidase gene in two patients with Pompe disease
 - Letter to the Editor
 - And what about septin 9 (SEPT9) as a binding partner of survivin in heart regeneration?