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Pediatric Graves’ disease in Argentina: analyzing treatment strategies and outcomes

  • Anna Rothenfusser EMAIL logo , Ana Chiesa and Patricia Papendieck
Published/Copyright: December 31, 2024
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 38 Issue 2

Abstract

Objectives

Graves’ disease is the leading cause of hyperthyroidism in children. Only a small percentage of pediatric patients achieve remission with anti-thyroid drug treatment (ATD), and both definitive therapies (thyroidectomy, or radioiodine thyroid ablation) cause lifelong hypothyroidism. Our objective was to evaluate the outcome of patients with pediatric Graves’ disease (PGD), treated at a single tertiary center, focusing on response to medical treatment, remission rate, adverse reactions (AR), definitive treatment (DT), and potential predictive factors for remission.

Methods

Data from clinical charts of 130 patients diagnosed with PGD between 2006 and 2021 were collected: epidemiological, clinical, biochemical characteristics, outcome, remission, adverse reactions (AR), and DT were registered. Predictive factors at diagnosis were evaluated for 88 patients diagnosed at our center.

Results

Our patients were 78 % female, 98 % Hispanic, with a median age of 12.7 years (range 1.7–17.3 years). Fourteen (11 %) had Down syndrome. Severe thyrotoxicosis (FT4>5.5 ng/dL) was seen at diagnosis in 66 %. Initially, 129/130 received ATD; during the study, 17 participants (13 %) reached remission, with a median ATD duration of 3.1 years (range 1.3–6.1 years). The chance of remaining hyperthyroid was 65 %. Only one patient relapsed 1.3 years post-ATD. Forty-six percent (59/129) needed DT, 31 % (40/129) were lost to follow-up, and 10 % (11/129) remained on ATD. AR affected 26 % of the patients and most (74 %) occurred within the first 3 months, half of them severe enough to discontinue ATD. No significant predictive factors were identified.

Results

ATD, our first-line treatment, resulted in low remission rates for Hispanic pediatric patients with severe thyrotoxicosis at diagnosis. Poor adherence issues contributed to the indication of DT (46 %) and loss to follow-up (31 %) during the studied period. Based on our findings, DT should be considered at 4 years of ATD in persisting PGD.

Conclusions

ATD, our first line treatment, resulted in low remission rates for Hispanic pediatric patients with severe thyrotoxicosis at diagnosis. Poor adherence issues contributed to the indication of DT (46 %) and loss to follow-up (31 %) during the studied period. Based on our findings, DT should be considered at 4 years of ATD in persisting PGD.

Keywords: adverse reaction to methimazole; antithyroid drugs; Down syndrome; long-term antithyroid therapy; hyperthyroidism; autoimmune thyroiditis
Corresponding author: Anna Rothenfusser, CONICET–FEI–División de Endocrinología, Centro de Investigaciones Endocrinológicas“Dr. César Bergadá” (CEDIE), Hospital de Niños Ricardo Gutiérrez, BuenosAires, Argentina, E-mail:

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: Use of Chat GPT to improve language.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The raw data can be obtained on request from the corresponding author

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Received: 2024-08-16
Accepted: 2024-11-26
Published Online: 2024-12-31
Published in Print: 2025-02-25

© 2024 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Effects of orlistat on body mass index and serum lipids in overweight and obese adolescents: a meta-analysis
  4. Psychological and behavioral assessments in girls with idiopathic central precocious puberty
  5. The effect of phlebotomy and placement of an intravenous catheter on plasma catecholamine and serum copeptin concentrations
  6. Laparoscopic adrenalectomy in children with diverse adrenal pathologies: the impact of pre-operative imaging in decision making process
  7. Short- to medium-term follow-up of normoponderal children and adolescents with subclinical hypothyroidism: a retrospective study of the last 15 years
  8. Newborn screening follow-up in Bavaria: height and weight in paediatric patients with congenital adrenal hyperplasia
  9. Patterns and determinants of serum amylase, lipase concentrations in Indian adolescents and youth with type 1 diabetes
  10. Pediatric Graves’ disease in Argentina: analyzing treatment strategies and outcomes
  11. Nephrogenic diabetes insipidus results from a novel in-frame deletion of AVPR2 gene in monozygotic-twin boys and their mother and grandmother
  12. Short Communication
  13. Does clonidine stimulate copeptin in children?
  14. Case Report and Review of the Literature
  15. Sialidosis type 1 in a Turkish family: a case report and review of literatures
  16. Case Reports
  17. Central precocious puberty in a toddler with hypothalamic hamartoma
  18. Autosomally dominantly inherited isolated gonadotropin deficiency via maternal assisted reproduction due to SOX10 mutation
  19. Unclear symptoms, early diagnosis and perfect outcome: a case diagnosed as sepiapterin reductase deficiency hidden behind vitamin B12 deficiency
https://doi.org/10.1515/jpem-2024-0394
Keywords for this article
adverse reaction to methimazole; antithyroid drugs; Down syndrome; long-term antithyroid therapy; hyperthyroidism; autoimmune thyroiditis

Articles in the same Issue

  1. Frontmatter
  2. Original Articles
  3. Effects of orlistat on body mass index and serum lipids in overweight and obese adolescents: a meta-analysis
  4. Psychological and behavioral assessments in girls with idiopathic central precocious puberty
  5. The effect of phlebotomy and placement of an intravenous catheter on plasma catecholamine and serum copeptin concentrations
  6. Laparoscopic adrenalectomy in children with diverse adrenal pathologies: the impact of pre-operative imaging in decision making process
  7. Short- to medium-term follow-up of normoponderal children and adolescents with subclinical hypothyroidism: a retrospective study of the last 15 years
  8. Newborn screening follow-up in Bavaria: height and weight in paediatric patients with congenital adrenal hyperplasia
  9. Patterns and determinants of serum amylase, lipase concentrations in Indian adolescents and youth with type 1 diabetes
  10. Pediatric Graves’ disease in Argentina: analyzing treatment strategies and outcomes
  11. Nephrogenic diabetes insipidus results from a novel in-frame deletion of AVPR2 gene in monozygotic-twin boys and their mother and grandmother
  12. Short Communication
  13. Does clonidine stimulate copeptin in children?
  14. Case Report and Review of the Literature
  15. Sialidosis type 1 in a Turkish family: a case report and review of literatures
  16. Case Reports
  17. Central precocious puberty in a toddler with hypothalamic hamartoma
  18. Autosomally dominantly inherited isolated gonadotropin deficiency via maternal assisted reproduction due to SOX10 mutation
  19. Unclear symptoms, early diagnosis and perfect outcome: a case diagnosed as sepiapterin reductase deficiency hidden behind vitamin B12 deficiency
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