Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves' disease: national long-term cohort study.
BACKGROUND
Drug-based therapy is usually the initial treatment for Graves' disease (GD) hyperthyroidism in children, but there is some debate about treatment duration.


OBJECTIVE
Our objective was to assess the effect of long-term carbimazole therapy on GD remission in children and its determinants.


METHODS
This was an observational prospective multicenter follow-up cohort study.


METHODS
Participants included 154 children newly diagnosed with GD between 1997 and 2002. The intention was to treat patients with three consecutive courses of carbimazole, each lasting 2 yr. Definitive treatment was performed in cases of poor compliance with antithyroid drug (ATD) treatment, thyrotoxicosis relapse, or major adverse effects of ATD treatment.


METHODS
The main outcome measure was remission for at least 18 months after the completion of each course of ATD treatment.


RESULTS
The median duration of follow-up was 10.4 (9.0-12.1) yr. Overall estimated remission rates (95% confidence interval) 18 months after the withdrawal of ATD treatment increased with time and were 20 (13-26), 37 (29-45), 45 (35-54), and 49 (40-57)% after 4, 6, 8, and 10 yr follow-up, respectively. A multivariate competing risk model revealed an independent positive effect of less severe forms of hyperthyroidism at diagnosis [subhazard ratio of 1 for patients with free T(4) <35 pmol/liter vs. 0.4 (0.20-0.80) for free T(4) ≥ 35 pmol/liter; P = 0.01] and of the presence of other autoimmune conditions [subhazard ratio of 2.23 (1.19-4.18); P = 0.01] on remission rate after medical treatment.


CONCLUSIONS
About half the patients achieved remission after carbimazole discontinuation, and there seems to be a plateau in the incidence of remission achieved after 8-10 yr ATD therapy.
Assistance Publique-Hopitaux de Paris, Hopital Robert Debré, Service d’Endocrinologie Pédiatrique, Centre de Référence des Maladies Endocriniennes Rares de la Croissance, INSERM Unité 676, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France. juliane.leger@rdb.aphp.fr
Juliane
J
Léger
Georges
G
Gelwane
Florentia
F
Kaguelidou
Meriem
M
Benmerad
Corinne
C
Alberti
D000293:Adolescent; D000465:Algorithms; D013956:Antithyroid Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D002648:Child; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006111:Graves Disease / Q000175:diagnosis* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D011379:Prognosis; D012074:Remission Induction; D013997:Time Factors; D016896:Treatment Outcome
D013956:Antithyroid Agents