Published online February 11, 2008
PEDIATRICS (doi:10.1542/peds.2007-1535)
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ARTICLE

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

Nicole S. Glaser, MD, Dennis M. Styne, MD for the Organization of Pediatric Endocrinologists of Northern California Collaborative Graves' Disease Study Group

Department of Pediatrics, University of California Davis, School of Medicine, Sacramento, California

OBJECTIVE. 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.

METHODS. 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.

RESULTS. 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.

Key Words: hyperthyroidism • Graves' disease • propylthiouracil

Abbreviations: T4— thyroxine • T3—triiodothyronine • SDS—SD score • TSI—thyroid-stimulating immunoglobulin • TBII—thyroid-binding inhibitory immunoglobulin • TPO—anti–thyroid peroxidase antibody • ANA—antinuclear antibody

Accepted Jul 21, 2007.




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