title: Graves' disease in children and adolescents: response to long-term treatment.
abstract: BACKGROUND
  Optimal treatment of Graves' disease in paediatric patients is still a matter of controversy. Antithyroid drugs, radioiodine and thyroidectomy are the three therapeutic options available.
  
  
  OBJECTIVE
  To report our experience of long-term medical treatment and outcome of paediatric Graves' disease.
  
  
  METHODS
  A 5-y-long medical protocol was implemented in 20 children and adolescents with Graves' disease. All patients received antithyroid drugs as the first therapeutic option; patients who did not enter long-term remission received I(131) and/or surgery as the definitive treatment.
  
  
  RESULTS
  The mean age at diagnosis was 12.1+/-4 y. Only two patients were males, both presenting concomitant type 1 diabetes. Mean follow-up was 13.8+/-5.5 y. Forty per cent of patients achieved long-term remission with low antithyroid drugs doses (mean treatment time: 5.4+/-1.4 y). Six patients received I(131) as definitive treatment and another six underwent surgery after completing medical treatment for 6.8+/-4.1 and 5.1+/-2 y, respectively. No patients requiring high antithyroid drugs doses to maintain euthyroidism reached long-term remission and needed I(131) and/or surgery.
  
  
  CONCLUSIONS
  Implementation of a long-term antithyroid drug protocol achieved 40% long-term remissions in paediatric patients with Graves' disease. Need for maintained high doses of antithyroid drugs could be considered a predictive factor for no remission. When permanent remission was not obtained by medical treatment, I(131)and/or surgery allowed healing in all cases.
authors.affiliation: Paediatric Endocrine Unit, Ramón y Cajal Hospital, Madrid, Spain. rbarrio.hrc@salud.madrid.org
authors.forename: Raquel
authors.initials: R
authors.lastname: Barrio
authors.forename: Marta
authors.initials: M
authors.lastname: López-Capapé
authors.forename: Itziar
authors.initials: I
authors.lastname: Martinez-Badás
authors.forename: Angel
authors.initials: A
authors.lastname: Carrillo
authors.forename: Jose C
authors.initials: JC
authors.lastname: Moreno
authors.forename: Milagros
authors.initials: M
authors.lastname: Alonso
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D013956:Antithyroid Agents / Q000008:administration & dosage*; D002648:Child; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D005260:Female; D006111:Graves Disease / Q000628:therapy*; D006801:Humans; D007457:Iodine Radioisotopes / Q000008:administration & dosage*; D008297:Male; D008713:Methimazole / Q000008:administration & dosage*; D013965:Thyroidectomy
chemical_list: D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D008713:Methimazole