Remission in pediatric Graves’ disease treated with antithyroid drug and the risk factors associated with relapse

Wong, Tsz Wai Catherine; Wong, M

doi:10.6065/apem.2244038.019

Cited by 3 publications

(2 citation statements)

References 36 publications

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“…Several studies over the past few decades have explored the efficacy and safety of long-term ATD therapy in children [14,15,[17][18][19]. A randomized trial comparing long-term (96-120 months) MMI treatment with short-term treatment (18-24 months) in pediatric GD found significantly higher remission rates in the long-term group: 92% at 1 year and 88% at 4 years post-MMI withdrawal, versus 46% and 33% in the short-term group, respectively [18].…”

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confidence: 99%

Updates in the Management of Graves Disease in Children

Lee

2023

Ewha Med J

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Graves disease (GD) is the primary cause of hyperthyroidism in children. The standard management options-namely, antithyroid drugs (ATD), radioactive iodine, and surgery-have not changed for many years. Although ATD therapy is often the first-line treatment for pediatric patients, the low likelihood of spontaneous remission means that most children will require a more permanent solution. Recent clinical trials and systematic reviews have shed light on the long-term outcomes of ATD therapy, radioactive iodine, and surgical interventions in managing pediatric GD. Additionally, novel therapies aimed at B-cells or the thyroid-stimulating hormone receptor, both implicated in the pathogenesis of GD, are under investigation. However, their definitive role in treating childhood GD has yet to be established. This review will cover the latest developments in the treatment of childhood GD, including information on emerging targeted therapies.

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Section: Main Textmentioning

confidence: 99%

Updates in the Management of Graves Disease in Children

Lee

2023

Ewha Med J

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“…In this study [ 8 ], the authors studied 81 Chinese children treated with ATD and reported that 17.8% experienced remission and 57.4% experienced relapse after discontinuation of ATD. In addition, although the remission rate through ATD treatment was low in Asian children with GD, the longer was the ATD treatment period, the higher was the remission probability.…”

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confidence: 99%

Commentary on “Remission in pediatric Graves’ disease treated with antithyroid drug and the risk factors associated with relapse”

Kim¹

2022

Ann Pediatr Endocrinol Metab

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Hyperthyroidism is a disease in which the thyroid produces excessive hormones and produces clinical symptoms. The most common cause of hyperthyroidism in children is Graves' disease (GD). Autoimmune hyperthyroidism can be diagnosed by measuring autoantibodies against the thyroid-stimulating hormone receptor. The goal of treatment is to control the overproduction of thyroid hormone, for which there are 3 options: antithyroid drug (ATD), radioactive iodine therapy, and surgery. Methimazole (MMZ) and propylthiouracil are used for drug treatment, although MMZ is mainly used in children because of its long serum half-life and low hepatotoxicity. The initial dose is MMZ 0.5 mg/kg/day, once or twice a day, and the dose titration method is most common. 1) Considering that the remission rate with ATD is not high, definite treatment is recommended if remission does not occur after 1 to 2 years of therapy with MMZ. However, there are few guidelines for children.Remission was defined as a euthyroid state for at least 12 months after discontinuation of ATD treatment and no recurrence during the follow-up period. Many studies have reported that the remission rate increases with ATD use period in children. A recent systematic review noted that the remission rate was 43.7% when ATD was used for 5-6 years and reached 75% after 9 years of treatment. 2) In 2022, the European Thyroid Association for the Management of Childhood GD also recommended extending initial ATD for at least 3 years and potentially for more than 5 years if remission is unlikely. 3) Factors related to remission differ from study to study, but the remission rate is low in males, 4) younger age at diagnosis, non-Caucasian ethnicity, higher TSH receptor antibody at diagnosis, 5) and larger goiter size. 6) There is also a report of an association between the time to TSH binding inhibitory immunoglobulin normalization after treatment and GD remission. 7) In this study, 8) the authors studied 81 Chinese children treated with ATD and reported that 17.8% experienced remission and 57.4% experienced relapse after discontinuation of ATD. In addition, although the remission rate through ATD treatment was low in Asian children with GD, the longer was the ATD treatment period, the higher was the remission probability. Since most relapses occur within the first 2 years after discontinuation of ATD, patients and their guardians should be educated about the long treatment period and the risk of recurrence when starting treatment.

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Unusual onset of Graves’ disease associated with thymic hyperplasia in a 5-year-old girl with congenital bilateral clinical anophthalmia: diagnostic and therapeutic challenges

Ben Rabeh,

Bouzidi,

Hamdi

et al. 2023

Journal of Pediatric Endocrinology and Metabolism

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Objectives Graves’ disease (GD) is a rare auto-immune disorder in pediatric population. The association between GD and thymic hyperplasia was rarely reported in children. Diagnosis and management of GD are challenging in children. Case presentation This report presents the case of a 5-year-old girl with a personal history of asthma and congenital bilateral isolated clinical anophthalmia who presented with acute congestive heart failure, sinus tachycardia and atypical signs of orbitopathy with edema and erythema of the lower right eyelid and excessive tearing. The diagnosis of GD was based on detecting a suppression of serum TSH level and the presence of high titers of TRAbs. Relapse occurred after 10 months of antithyroid drugs with chief complaints of palpitations, dyspnea and dysphagia. Computed tomography showed heterogeneous anterior mediastinal mass with no invasion into the surrounding tissue. The marked shrinkage of the mass after radioiodine therapy supported the diagnosis of thymic hyperplasia associated with GD. Conclusions The presence of clinical anophthalmia may be a confusing factor for the diagnosis of Gravesʼ ophthalmopathy. Recognition of the association between GD and thymic hyperplasia would avoid invasive diagnostic procedures and unnecessary surgical resection. Radioiodine therapy may be used in young children with repeated relapses of GD.

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Remission in pediatric Graves’ disease treated with antithyroid drug and the risk factors associated with relapse

Cited by 3 publications

References 36 publications

Updates in the Management of Graves Disease in Children

Updates in the Management of Graves Disease in Children

Commentary on “Remission in pediatric Graves’ disease treated with antithyroid drug and the risk factors associated with relapse”

Unusual onset of Graves’ disease associated with thymic hyperplasia in a 5-year-old girl with congenital bilateral clinical anophthalmia: diagnostic and therapeutic challenges

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