Predicting the Likelihood of Remission in Children With Graves' Disease: A Prospective, Multicenter Study

• Published in: Pediatrics (Evanston) 2008-03, Vol.121 (3), p.e481-e488
• Main Authors: Glaser, Nicole S, Styne, Dennis M, Organization of Pediatric Endocrinologists of Northern California Collaborative Graves' Disease Study Group
• Format: Article
• Language: English
• Subjects: Adolescent; Age Factors; Antithyroid Agents - administration & dosage; Child; Children & youth; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Graves Disease - diagnosis; Graves Disease - drug therapy; Hormones; Humans; Logistic Models; Male; Multivariate Analysis; Pediatrics; Predictive Value of Tests; Propylthiouracil - administration & dosage; Prospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Studies; Thyroid diseases; Thyroid Function Tests; Treatment Outcome
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2007-1535

The optimal treatment for Graves' disease in children is controversial. Antithyroid medications are often used initially, but many children eventually require alternative therapies. We evaluated predictors of remission after 2 years of antithyroid medication use. We prospectively studied children who had Graves' disease and were treated with antithyroid medications. We compared children who achieved remission after 2 years with those who had persistent disease to determine which variables were associated with remission; multiple logistic regression and binary recursive partitioning analyses were used to evaluate interactions among predictive variables. Of 51 children who completed the study, 15 (29%) achieved remission. Children who achieved remission had lower thyroid hormone concentrations at presentation than those with persistent disease (free thyroxine: 6.17 +/- 3.10 vs 9.86 +/- 7.54 ng/dL; total triiodothyronine: 431 +/- 175 vs 561 +/- 225 ng/dL). Children who achieved remission were also more likely to be euthyroid within 3 months of initiating propylthiouracil (82% vs 29%). Binary recursive partitioning analysis identified rapid achievement of euthyroid status after initiation of propylthiouracil, lower initial triiodothyronine, and older age as significant predictors of remission. CONCLUSIONS; Thyroid hormone concentrations at diagnosis, age, and initial response to propylthiouracil can be used to stratify patients according to the likelihood of remission after 2 years of antithyroid medication use. These data provide a useful guide for clinical decision-making regarding Graves' disease in children.