Persistence of Thyrotropin (TSH) Receptor Antibodies in Children and Adolescents with Graves' Disease Treated Using Antithyroid Medication
Abstract
Objective : To determine the course of thyrotropin (thyroid-stimulating hormone [TSH]) receptor antibodies (TRAbs) in children and adolescents with Graves' disease treated using antithyroid drugs (ATDs). Design : Retrospective, cross-sectional study of 86 children and adolescents with Graves' disease treated medically for >3 years. Patients with Hashimoto's thyroiditis and idiopathic short stature ( n = 30) served as controls. A second-generation enzyme-linked immunosorbent assay (ELISA) for TRAbs was used. Main outcomes : Twenty-two out of 23 (95.7%) patients with newly diagnosed Graves' disease, but 0/30 controls, had detectable TRAbs (22.0 ± 13.5 U/L [mean ± SD] vs. 0.9 ± 0.9 U/L, p < 0.0001). Mean TRAb levels decreased with duration of therapy, but even after 13–24 months, TRAbs had normalized in only 3/16 (18.8%) patients. The initial TRAb titer correlated significantly with severity of the initial hyperthyroidism, but did not predict the response to therapy as indicated by the dosage of ATD required to control the hyperthyroidism at 6 and 12 months. Conclusion : Unlike adults, most children and adolescents with Graves' disease require >2 years of ATD treatment before TRAbs are normalized. Although initial TRAb activity reflects disease severity, it does not predict the response to medical therapy. Recommendations as to treatment duration developed for adult patients should not be applied to the young.
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TRAb levels persist longer in children than in adults.
“Therefore, it appears that TRAb levels persist longer in children than in adults (346).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [346]
A recent study found that TRAb levels normalized after 24 months in only 18% of pediatric patients on ATDs.
“A recent study found that TRAb levels normalized after 24 months in only 18% of pediatric patients on ATDs (346).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [346]
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“A recent study found that TRAb levels normalized after 24 months in only 18% of pediatric patients on ATDs (346).”
BackgroundBahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098 · see citing works
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Pediatric Graves’ disease: management in the post-propylthiouracil Era
Rivkees, S. A. (2014) · International Journal of Pediatric Endocrinology · doi:10.1186/1687-9856-2014-10 · Cited by 46 · see citing works
“GD is due to thyroid gland stimulation by thyroid receptor antibodies [TRAbs; or thyroid stimulating immunoglobulins (TSI)] [3].”
Background
- Authors
- Smith, J., & Brown, R. S.
- Affiliations
- Boston Children's Hospital (US)
- ORCID
- Smith, Jessica
- Venue
- Thyroid®
- Publisher
- SAGE Publications
- Published
- 2007-11
- Volume
- 17
- Issue
- 11
- Pages
- 1103-1107
- ISSN
- 1050-7256 (ISSN-L)
- 1557-9077
- OpenAlex
- W2114765813
- Cited by
- 39
- References
- 25
- Citations by year
- 2024: 1 · 2021: 1 · 2020: 4 · 2018: 2 · 2017: 5 · 2016: 3 · 2015: 3 · 2014: 4 · 2013: 2 · 2012: 4
- FWCI
- 1.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Thyroid (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (T32 DK 07699-23, T32DK007699)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- Graves' disease, TSH receptor antibodies, antithyroid drugs, treatment response prediction, treatment duration, Hashimoto's thyroiditis, idiopathic short stature
- MeSH terms
- Adolescent, Autoantibodies, Child, Cross-Sectional Studies, Female, Graves Disease, Humans, Male, Predictive Value of Tests, Receptors, Thyrotropin, Retrospective Studies, Antithyroid Agents, Immunoglobulins, Thyroid-Stimulating
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