Background: The remission rate in children with Graves' disease (GD) after 2-6 years of antithyroid drug (ATD) treatment is 40-50%. It has been reported that it is difficult to predict the GD prognosis based on the thryroid stimulating hormone (TSH) receptor antibody (TRAb) level at the cessation of ATD treatment. We studied whether the persistence of negative TRAb at ATD treatment cessation increased the remission rate in pediatric patients with GD.
Methods: We included 22 patients diagnosed with GD who discontinued ATD treatment after confirmation of negative TRAb on two or more consecutive tests. Remission was defined as the maintenance of normal thyroid function, including serum TSH level, with negative TRAb more than 2 years after ATD discontinuation.
Results: Of the 22 patients, 12 achieved remission (remission rate 54.5%), with no significant between-group difference in the median duration of ATD treatment in the remission and relapse groups (4.4 vs 3.9 years). Of the 10 patients who relapsed, four (40.0%) relapsed within 2 years after ATD discontinuation, and 4 (40.0%) relapsed more than 5 years after ATD discontinuation.
Conclusions: The persistence of negative TRAb at ATD treatment cessation might indicate prolonged duration of remission but does not increase the final remission rate in patients with childhood-onset GD.
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Article Synopsis
- Graves disease (GD) is the main cause of hyperthyroidism but often shows different symptoms like tachycardia and weight loss instead of the typical signs.
- Treatment options include antithyroid drugs (ATDs), radioactive iodine (RAI), and surgery, each with notable side effects and potential complications such as ATD resistance.
- A complex case study of a 58-year-old woman with MMI-resistant GD illustrates the difficulties in treatment, leading to successful management with RAI therapy after unsuccessful attempts with high doses of MMI.
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