Positive Impact of Long-Term Antithyroid Drug Treatment on the Outcome of Children with Graves' Disease: National Long-Term Cohort Study
Abstract
CONTEXT: Drug-based therapy is usually the initial treatment for Graves' disease (GD) hyperthyroidism in children, but there is some debate about treatment duration. OBJECTIVE: Our objective was to assess the effect of long-term carbimazole therapy on GD remission in children and its determinants. DESIGN AND SETTING: This was an observational prospective multicenter follow-up cohort study. PARTICIPANTS: Participants included 154 children newly diagnosed with GD between 1997 and 2002. The intention was to treat patients with three consecutive courses of carbimazole, each lasting 2 yr. Definitive treatment was performed in cases of poor compliance with antithyroid drug (ATD) treatment, thyrotoxicosis relapse, or major adverse effects of ATD treatment. MAIN OUTCOME MEASURE: The main outcome measure was remission for at least 18 months after the completion of each course of ATD treatment. RESULTS: The median duration of follow-up was 10.4 (9.0-12.1) yr. Overall estimated remission rates (95% confidence interval) 18 months after the withdrawal of ATD treatment increased with time and were 20 (13-26), 37 (29-45), 45 (35-54), and 49 (40-57)% after 4, 6, 8, and 10 yr follow-up, respectively. A multivariate competing risk model revealed an independent positive effect of less severe forms of hyperthyroidism at diagnosis [subhazard ratio of 1 for patients with free T(4) <35 pmol/liter vs. 0.4 (0.20-0.80) for free T(4) ≥ 35 pmol/liter; P = 0.01] and of the presence of other autoimmune conditions [subhazard ratio of 2.23 (1.19-4.18); P = 0.01] on remission rate after medical treatment. CONCLUSION: About half the patients achieved remission after carbimazole discontinuation, and there seems to be a plateau in the incidence of remission achieved after 8-10 yr ATD therapy.
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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 [337]
The use of MMI in this group of children was associated with a very low rate of medication side effects.
“The use of MMI in this group of children was associated with a very low rate of medication side effects (337).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [337]
A recent prospective report from France shows that with prolonged ATD use, remission rates of up to 49% could be achieved.
“Whereas most studies, including recent large database reports (343), show that the vast majority of patients treated for GD with ATDs do not go into remission, a recent prospective report from France shows that with prolonged ATD use, remission rates of up to 49% could be achieved.”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [337]
This study reported remission rates of 20%, 37%, 45%, and 49% after 4, 6, 8, and 10 years follow-up of 154 children treated with ATDs.
“This study reported remission rates of 20%, 37%, 45%, and 49% after 4, 6, 8, and 10 years follow-up of 154 children treated with ATDs (337).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [337]
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 [337]
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References 39 · Cited by 144
- Authors
- Léger, J., Gelwane, G., Kaguelidou, F., Benmerad, M., Alberti, C., & the French Childhood Graves' Disease Study Group
- Affiliations
- Inserm (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Léger, Juliane
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2012-01
- Volume
- 97
- Issue
- 1
- Pages
- 110-119
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1985645241
- Cited by
- 144
- References
- 39
- Citations by year
- 2026: 7 · 2025: 1 · 2024: 6 · 2023: 7 · 2022: 13 · 2021: 14 · 2020: 13 · 2019: 19 · 2018: 12 · 2017: 7 · 2016: 6 · 2015: 15 · 2014: 14 · 2013: 5 · 2012: 4
- FWCI
- 6.03
- 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, pediatric hyperthyroidism, carbimazole, remission, treatment withdrawal, free thyroxine, autoimmune disease comorbidity, medication adherence
- MeSH terms
- Adolescent, Algorithms, Child, Female, Follow-Up Studies, France, Graves Disease, Humans, Male, Prognosis, Remission Induction, Antithyroid Agents, Time Factors, Cohort Studies, Treatment Outcome
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