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Hyperthyroidism in Children Treated with Long Term Medical Therapy: Twenty-Five Percent Remission Every Two Years*
Abstract
We use an antithyroid drug for the treatment of hyperthyroidism due to Graves' disease in children and adolescents for as long as the patients are willing to comply and/or tolerate the drug. In more than 60 patients treated since 1961, the remission rate was 25% in the first 2 yr. This report looks at these same patients again, followed for an additional 5 yr. Survival analysis methods applied to the follow-up data on 63 children confirm our original statistical findings and suggest a continuing remission rate of 25% every 2.1 +/- 0.4 (+/- SE) yr regardless of the duration of previous therapy. The median time to remission was 4.3 +/- 1.5 yr, and 75% of patients are predicted to be in remission in 10.9 +/- 2.3 yr. Of 36 patients who went into remission, defined by their being euthyroid for 1 yr after cessation of therapy, 1 relapsed, and 2 developed spontaneous hypothyroidism; the remainder are euthyroid 1-11.7 yr after therapy was discontinued. Of 14 who switched from medical therapy, 2 of 7 treated surgically and 4 of 7 treated with 131I are hypothyroid. Only 1 patient had a significant adverse reaction to both methimazole and propylthiouracil. While medical therapy may have some direct effect on the autoimmune response in hyperthyroidism, its role in affecting the time to ultimate remission is unknown. These data, however, describe the course of children so treated and allow us to present therapeutic options initially or during treatment based on statistically derived probabilities of outcome.
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“Although two decades ago it was suggested that 25% of children with GD go into remission with every 2 years of continued treatment (341), other studies of larger cohorts of pediatric patients with GD treated with ATDs for extended periods have not revealed similar remission rates (333,339,342).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [341]
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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
“Although two decades ago it was suggested that 25% of children with GD go into remission with every 2 years of continued treatment (341), other studies of larger cohorts of pediatric patients with GD treated with ATDs for extended periods have not revealed similar remission rates (333,339,342).”
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
“Although two decades ago it was suggested that 25% of children with GD go into remission with every 2 years of continued treatment (220), other studies of larger cohorts of pediatric patients with GD treated with ATDs for extended periods have not revealed similar remission rates (213,216,221).”
BackgroundThe American Thyroid Association and American Association of Clinical Endocrinologists Taskforce on Hyperthyroidism and Other Causes of Thyrotoxicosis, Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., et al. (2011) · Thyroid · doi:10.1089/thy.2010.0417 · Cited by 898
“Although two decades ago it was suggested that 25% of children with GD go into remission with every 2 years of continued treatment (220), other studies of larger cohorts of pediatric patients with GD treated with ATDs for extended periods have not revealed similar remission rates (213,216,221).”
BackgroundLaurberg, P., Wallin, G., Tallstedt, L., Abraham-Nordling, M., Lundell, G., & Tørring, O. (2008) · European Journal of Endocrinology · doi:10.1530/eje-07-0450 · Cited by 428
The Management of Hyperthyroidism
Wood, A. J. J., & Franklyn, J. A. (1994) · New England Journal of Medicine · doi:10.1056/nejm199406163302407 · Cited by 302
Metadata
- Authors
- LIPPE, B. M., LANDAW, E. M., & KAPLAN, S. A.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 1987-06
- Volume
- 64
- Issue
- 6
- Pages
- 1241-1245
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W1992904825
- Cited by
- 192
- References
- 0
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2023: 4 · 2022: 2 · 2021: 4 · 2020: 8 · 2019: 15 · 2018: 9 · 2017: 5 · 2016: 3 · 2015: 7 · 2014: 12 · 2013: 3 · 2012: 7
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r01am025744-06)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Ophthalmology › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- pediatric hyperthyroidism, Graves' disease, antithyroid drug therapy, long-term medical therapy, remission rate, time to remission, hypothyroidism, relapse, methimazole, propylthiouracil, adverse drug reactions, survival analysis, treatment outcome prediction
- MeSH terms
- Child, Female, Graves Disease, Humans, Hyperthyroidism, Male, Methimazole, Propylthiouracil, Statistics as Topic, Time Factors
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