title: 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.
authors.affiliation: Department of Pediatrics, University of California, Davis, School of Medicine, 2516 Stockton Blvd, Sacramento, CA 95817, USA. nsglaser@ucdavis.edu
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Glaser
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Styne
mesh_terms: D000293:Adolescent; D000367:Age Factors; D013956:Antithyroid Agents / Q000008:administration & dosage*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011441:Propylthiouracil / Q000008:administration & dosage*; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013960:Thyroid Function Tests; D016896:Treatment Outcome
chemical_list: D013956:Antithyroid Agents; D011441:Propylthiouracil