Predictors of Autoimmune Hyperthyroidism Relapse in Children after Discontinuation of Antithyroid Drug Treatment
Abstract
CONTEXT: There is debate about how Graves' disease (GD) should be treated in children. OBJECTIVE: The aim of this study was to identify predictors of relapse after antithyroid drug (ATD) treatment in children with GD. STUDY DESIGN AND SETTING: We conducted a prospective, multicenter cohort study of children (n = 154) with GD treated with carbimazole for an intended duration of 24 +/- 3 months. After the end of treatment, patients were followed up for at least 2 yr. The primary outcome was hyperthyroidism relapse. Cox's regression analysis was used and a prognostic score was constructed. RESULTS: The overall estimated relapse rate for hyperthyroidism was 59% (95% confidence interval 52-67%) at 1 yr and 68% (95% confidence interval 60-76%) at 2 yr after the end of treatment. Multivariate survival analysis showed that the risk of relapse was higher for patients of non-Caucasian origin [hazard ratio (HR) = 2.54, P < 0.001], with high serum thyroid-stimulating hormone receptor antibodies (HR = 1.21 by 10 U, P = 0.03) and free T(4) (HR = 1.18 by 10 pmol/liter, P = 0.001) levels at diagnosis. Conversely, relapse risk decreased with increasing age at onset (HR = 0.74 per 5 yr, P = 0.03) and duration of first course of ATD (HR = 0.57 per 12 months, P = 0.005). A prognostic score was constructed, allowing the identification of three different risk groups, with 2-yr relapse rates of 46, 77, and 98%. CONCLUSIONS: A longer initial duration of euthyroid state with ATD seems to be the only variable related to the risk of hyperthyroidism relapse in children that can be manipulated. Ethnic origin, age, and severity of the disease at diagnosis may guide long-term disease management decisions.
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Younger children and those with high initial thyroid hormone levels were found to be less likely to achieve remission within 2 years in prospective studies.
“Younger children and those with high initial thyroid hormone levels were also found to be less likely to achieve remission within 2 years in the prospective studies (334,337).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [334]
The overall rate of side effects from ATDs (both major and minor) in children has been reported to be 6%-35%.
“The overall rate of side effects from ATDs (both major and minor) in children has been reported to be 6%-35% (332,334,336,337).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [334]
MMI-related adverse events include allergic reactions, rashes, myalgias, and arthralgias, as well as hypothyroidism from overtreatment.
“MMI-related adverse events include allergic reactions, rashes, myalgias, and arthralgias (333,334), as well as hypothyroidism from overtreatment.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [334]
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- Authors
- Kaguelidou, F., Alberti, C., Castanet, M., Guitteny, M.-A., Czernichow, P., & Léger, J.
- Affiliations
- Inserm (FR)
- Corresponding author
- Léger, Juliane
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-10
- Volume
- 93
- Issue
- 10
- Pages
- 3817-3826
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2046379714
- Cited by
- 173
- References
- 45
- Citations by year
- 2026: 7 · 2025: 3 · 2024: 7 · 2023: 7 · 2022: 12 · 2021: 12 · 2020: 9 · 2019: 12 · 2018: 14 · 2017: 10 · 2016: 5 · 2015: 12 · 2014: 14 · 2013: 10 · 2012: 8
- FWCI
- 7.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- 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, autoimmune hyperthyroidism, relapse, children, antithyroid drugs, carbimazole, prognostic factors, TSH receptor antibodies, free thyroxine, ethnicity, age of onset, prognostic score
- MeSH terms
- Adolescent, Algorithms, Autoimmune Diseases, Carbimazole, Child, Female, Follow-Up Studies, Graves Disease, Humans, Hyperthyroidism, Male, Prognosis, Recurrence, Risk Factors, Antithyroid Agents, Withholding Treatment
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