Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment

Abstract

A longer initial duration of euthyroid state with ATD seems to be the only variable related to the risk of hyperthyroidism relapse in children that can be manipulated. Ethnic origin, age, and severity of the disease at diagnosis may guide long-term disease management decisions.

Management of thyrotoxicosis in children and adolescents: 35 years’ experience in 304 patients

“…There is some controversy on the use of MMI as a first-line treatment of pediatric hyperthyroidism and we used, similar to other studies, methimazole as the first-line therapy in all patients [19,20,[22][23][24][25]. Remission rates after ATD withdrawal varied in different studies ranging from 33% to 64% [6,23,26].…”

“…Many retrospective studies [19,25,31,32] and one prospective study have shown that the duration of medical treatment may be a predictive marker of relapse in juvenile hyperthyroidism. Another prospective study showed that relapse risk of hyperthyroidism decreased with the duration of the first course of ATD and every additional year of ATD therapy was associated with a decrease in the relapse rate [20]. Another study evaluated the effect of the duration of ATD treatment after three consecutive courses, each lasting for 2 years and found a remission rate of 50% after discontinuation of ATD treatment [24].…”

“…Most patients are initially treated with ATD. However, the remission rate in children is lower than in adults and is achieved in <30% of children after a first course of antithyroid therapy achieved for 2 years [19][20][21]. Therefore, many patients who are initially treated medically eventually receive ablative treatment, most often radioiodine [22,23].…”

“…On the other hand, many patients continue ATD, after relapse, fearing occurrence of complications of radioiodine treatment and thyroidectomy. Little is known about the long-term treatment with ATD, as only a few studies have been reported regarding the outcome of continuous ATD and of the relationship between ATD treatment duration and remission or relapse in children and adolescents with hyper thyroidism [19,20,24].…”

The role of long term use of antithyroid drugs in Graves’ disease

“…However, it is difficult to achieve long-term compliance and the rate of relapse is high in children. Remission is achieved in less than 30% of children after a first course of ATD for about 2 years (18). In children, studies have shown that a longer initial duration of euthyroid state with ATD is associated with a lower risk of relapse after a first course of ATD therapy (18,19).…”