Endocrine Abstracts

Introduction: Anti-thyroid medications are the first line therapy for children and young people with Grave’s disease (GD). Some studies have shown remission rates up to 40–50%; however long-term follow up studies have reported much lower remission rates in children compared to adults.

Aim: To review the long-term follow up and management of adolescents with Grave’s disease in a single tertiary centre in the UK.

Methods: This is a retrospective study of 37 patients with Grave’s disease who attended the tertiary endocrine outpatient clinic between 2007 and 2017. Patients who were excluded consisted of Hashimoto’s thyrotoxicosis, unclear diagnosis of Grave’s disease and patients with incomplete data on the system.

Results: 37 patients [M:F, 3.9:1] with Grave’s disease were included with a mean age of 12.16 years (S.D ± 3.3). In the sample studied, 27 (73%) received ‘block and replace’ therapy (carbimazole and thyroxine) whilst 7 (19%) received carbimazole only (titration regimen). The average duration of treatment for ‘block and replace’ was 30 months (range 3–62). The average duration of treatment for carbimazole only was 21.8 months (range 2–36). Out of the 27 patients who received ‘block and replace’ therapy, 8 patients were still receiving ongoing treatment at the time of data collection. 14 patients had a trial ‘off medication’ and the average duration of remission was 9.4 months (range 0.25–21). Out of the 7 patients who received carbimazole only, 5 of them had a trial ‘off medication’ and the average duration of remission was 10.3 months (range 2–24). In the ‘block and replace’ group, only 1 out of 14 (7.1%) patients achieved remission. For carbimazole only group, one patient (out of 5, 20%) achieved remission.

Conclusion: Majority of children tend to relapse after anti-thyroid medications and require definitive treatment in the long term. Larger prospective studies are essential to understand the predictive factors for long term remission which would allow clinicians to develop criteria for medical vs surgery/radioiodine therapy.