title: Persistence of thyrotropin (TSH) receptor antibodies in children and adolescents with Graves' disease treated using antithyroid medication.
abstract: OBJECTIVE
  To determine the course of thyrotropin (thyroid-stimulating hormone [TSH]) receptor antibodies (TRAbs) in children and adolescents with Graves' disease treated using antithyroid drugs (ATDs).
  
  
  METHODS
  Retrospective, cross-sectional study of 86 children and adolescents with Graves' disease treated medically for >3 years. Patients with Hashimoto's thyroiditis and idiopathic short stature (n = 30) served as controls. A second-generation enzyme-linked immunosorbent assay (ELISA) for TRAbs was used.
  
  
  RESULTS
  Twenty-two out of 23 (95.7%) patients with newly diagnosed Graves' disease, but 0/30 controls, had detectable TRAbs (22.0 +/- 13.5 U/L [mean +/- SD] vs. 0.9 +/- 0.9 U/L, p < 0.0001). Mean TRAb levels decreased with duration of therapy, but even after 13-24 months, TRAbs had normalized in only 3/16 (18.8%) patients. The initial TRAb titer correlated significantly with severity of the initial hyperthyroidism, but did not predict the response to therapy as indicated by the dosage of ATD required to control the hyperthyroidism at 6 and 12 months.
  
  
  CONCLUSIONS
  Unlike adults, most children and adolescents with Graves' disease require >2 years of ATD treatment before TRAbs are normalized. Although initial TRAb activity reflects disease severity, it does not predict the response to medical therapy. Recommendations as to treatment duration developed for adult patients should not be applied to the young.
authors.affiliation: Division of Endocrinology, Children's Hospital Boston and Harvard University School of Medicine, Boston, MA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Smith
authors.forename: Rosalind S
authors.initials: RS
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D013956:Antithyroid Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001323:Autoantibodies / Q000097:blood*; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006111:Graves Disease / Q000188:drug therapy* / Q000276:immunology*; D006801:Humans; D018828:Immunoglobulins, Thyroid-Stimulating; D008297:Male; D011237:Predictive Value of Tests; D011989:Receptors, Thyrotropin / Q000276:immunology*; D012189:Retrospective Studies