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Licensed Unlicensed Requires Authentication Published by De Gruyter June 19, 2014

Long-term outcomes of pediatric Graves’ disease

  • Ganesh Jevalikar EMAIL logo , Julieta Solis and Margaret Zacharin

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.


Corresponding author: Ganesh Jevalikar, Division of Endocrinology and Diabetes, Medanta The Medicity, Sector 38, Gurgaon (Haryana), 122001, India, Phone: +91-124-4141414 (Ext. 6518), Fax: +91-124-4834111, E-mail:

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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Received: 2013-8-21
Accepted: 2014-5-16
Published Online: 2014-6-19
Published in Print: 2014-11-1

©2014 by De Gruyter

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