Predicting the Likelihood of Remission in Children With Graves’ Disease: A Prospective, Multicenter Study
Abstract
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.
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In children, when ATDs are used for 1-2 years, remission rates are generally 20%-30%, with remission defined as being euthyroid for 1 year after cessation of therapy.
“In children, when ATDs are used for 1-2 years, remission rates are generally 20%-30%, with remission defined as being euthyroid for 1 year after cessation of therapy (333,339,340).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [339]
In another large cohort of 184 medically treated children, after 1 year of therapy with ATDs, 10% were in remission; after 2 years, 14%; after 3 years, 20%; and after 4 years, 23%.
“In another large cohort of 184 medically treated children, after 1 year of therapy with ATDs, 10% were in remission; after 2 years, 14%; after 3 years, 20%; and after 4 years, 23% (339,342).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [339]
Retrospective studies have suggested that the chance of remission after 2 years of ATDs is low if the thyroid gland is large (more than 2.5 times normal size for age), the child is young (<12 years) or not Caucasian, serum TRAb levels are above normal on therapy, or free T4 levels are substantially elevated at diagnosis (>4 ng/dL, 50 pmol/L).
“Retrospective studies have suggested that the chance of remission after 2 years of ATDs is low if the thyroid gland is large (more than 2.5 times normal size for age), the child is young (<12 years) or not Caucasian, serum TRAb levels are above normal on therapy, or free T 4 levels are substantially elevated at diagnosis (>4 ng/dL, 50 pmol/L) (339).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [339]
Other studies of larger cohorts of pediatric patients with GD treated with ATDs for extended periods have not revealed similar remission rates.
“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 [339]
When RAI activities >150 μCi/g (>5.55 MBq/g) are administered, hypothyroidism rates are about 95%.
“When RAI activities >150 lCi/g (>5.55 MBq/g) are administered, hypothyroidism rates are about 95% (88,339,349).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [339]
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- Authors
- Glaser, N. S., Styne, D. M., & for the Organization of Pediatric Endocrinologists of Northern California Collaborative Graves’ Disease Study Group
- Affiliations
- University of California, Davis (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2008-03-01
- Volume
- 121
- Issue
- 3
- Pages
- e481-e488
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W2080637533
- Cited by
- 125
- References
- 32
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 2 · 2021: 8 · 2020: 10 · 2019: 12 · 2018: 10 · 2017: 6 · 2016: 7 · 2015: 8 · 2014: 10 · 2013: 8 · 2012: 9
- FWCI
- 5.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Quest Diagnostics
- 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 Graves' disease, remission prediction, antithyroid drugs, propylthiouracil, thyroid hormone levels, free thyroxine, triiodothyronine, euthyroid status, prognostic factors, age
- MeSH terms
- Adolescent, Age Factors, Child, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Follow-Up Studies, Graves Disease, Humans, Male, Predictive Value of Tests, Propylthiouracil, Prospective Studies, Severity of Illness Index, Sex Factors, Antithyroid Agents, Thyroid Function Tests, Multivariate Analysis, Logistic Models, Treatment Outcome, Risk Assessment
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