Endocrine Abstracts

Introduction: Graves’ disease (GD) is the most common cause of hyperthyroidism in children. Therapeutic options available (anti-thyroid drugs, radioactive iodide, and thyroidectomy) are associated with complications and treatment of this age group remains controversial.

Objective: To review our experience in the management of pediatric patients with GD.

Materials and methods: Retrospective review of 35 children, diagnosed between 1984 and 2010, at Pediatric Endocrinology Unity of CHUC.

Results: 35 children followed, 85.7% females, 11.3±2.5-year-old (7–18), 53.3% prepubertal. Anxiety (60%), goiter (60%), weight loss (45.7%), tremor (42.9%), palpitations (34.3%), and exophthalmos (37.1%) were the most frequent initial manifestations. Mean duration of symptoms of 11.3±2.5 months. Analytically, increased FT₄ in 88.9% (mean 4.1±1.4 ng/dl; normal: 0.8–1.9), FT₃ in 94.4% (mean 12.9± 5.8 pg/ml; normal: 1.4–4.4), supressed TSH in 96.9%. TRAbs were positive in 91.1% (P50 13.3 IU/l, normal: <1). All children started anti-thyroid drugs, 68.9% methimazole (mean 0.4 mg/kg/weight/day), and 31.4% propylthiouracil (mean 5.4 mg/kg/weight/day). No severe side effects recorded. After normalization of thyroid hormones levothyroxine was started in 85.7%, on average 3.8±2.9 months after initiation of medical treatment. During follow-up: 10 (28.6%) children were in remission after 29±11.4 months of medical treatment, 6 (17.6%) underwent thyroidectomy and 4 (11.8%) to radioactive iodide after 25. 7±15.9 months of treatment. 14 children still maintain medical therapy for 22.3±11.4 months. In children who underwent definitive therapy (surgery or radioactive iodide) there was a significant difference in duration of symptoms (9.3±7.1 vs 3.8±2.0 months, P=0.035), FT₄ levels (4.7±1.2 vs 3.1±1.2 ng/ml, P=0.041), and FT₃ (15.4±3.1 vs 8.8±4.9 pg/ml, P=0.056).

Conclusion: In this series, medical treatment remained the initial option for all patients. Remission rate was 28.6% after an average of 2.5 years of treatment with anti-thyroid drugs. Diagnostic delay as well as higher levels of FT₄ and FT₃ at presentation were associated with unlikelihood of remission and the need for a definitive treatment.