Korean J Pediatr.  2009 Sep;52(9):1021-1028. 10.3345/kjp.2009.52.9.1021.

Remission rate and remission predictors of Graves disease in children and adolescents

• Lee SH
• Lee SY
• Chung HR
• Kim JH
• Kim JH
• Lee YA
• Yang SW
• Shin CH

• KMID: 2281258
• DOI: http://doi.org/10.3345/kjp.2009.52.9.1021

Abstract

PURPOSE
Medical therapy is the initial treatment for children with Graves disease to avoid complications of other treatments. However, optimal treatment for childhood Graves disease is controversial because most patients require relatively long periods of medical therapy and relapse is common after medication discontinuation. Therefore, this study aimed to search clinical or biochemical characteristics that could be used as remission predictors in Graves disease. METHODS: We retrospectively studied children diagnosed with Graves disease, treated with anti-thyroid agents, and observed for at least 3 years. Patients were categorized into remission and non-remission groups, and the groups were compared to determine the variables that were predictive of achieving remission.
RESULTS
Sixty-four patients were enrolled, of which 37 (57.8%) achieved remission and 27 (42.2%) could not achieve remission until the last visit. Normalization of thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) after treatment was faster in the remission group than in the non-remission group (remission group, 15.5+/-12.1 vs. nonremission group, 41.7+/-35.7 months). Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 28 patients. Only 2 (7.7%) of 26 patients who showed normal or hyper-response in TRH stimulation test relapsed. Binary logistic regression analysis identified rapid achievement of TBII normalization after treatment as a significant predictor of remission. Six percent of patients achieved remission within 3 years and 55.8% achieved it within 6 years.
CONCLUSION
Rapid achievement of TBII normalization can be a predictor of remission in childhood Graves disease. The TRH stimulation test can be a predictor of maintenance of remission.

Keyword

Graves disease; Antithyroid agents; Remission; Predictor; Childhood

MeSH Terms

Achievement
Adolescent
Antithyroid Agents
Child
Graves Disease
Humans
Immunoglobulins
Logistic Models
Recurrence
Retrospective Studies
Thyrotropin-Releasing Hormone
Antithyroid Agents
Immunoglobulins
Thyrotropin-Releasing Hormone