title: Long-term outcomes of pediatric Graves' disease.
abstract: BACKGROUND
  Remission rates with antithyroid drugs (ATDs) in pediatric Graves' disease (GD) are low. Very few studies report long-term follow-up of GD especially into adulthood.
  
  
  OBJECTIVE
  We studied long-term outcomes of pediatric onset GD, including a follow-up into adulthood and factors associated with need for definitive therapy.
  
  
  METHODS
  Sixty-five patients (57 females) with GD, with onset <18 years (median 13, range, 3.5-17) and duration ≥2 years (median 7; range, 2-22) since diagnosis, were included. Medical records were reviewed, and current details were recorded in a questionnaire by telephonic interview.
  
  
  RESULTS
  All patients were initially treated with ATDs. Fifty-three patients were treated for ≥2 years. Amongst these, outcomes included relapse after initial remission (n=38), failure of remission (n=8) and long-term remission, defined as remission lasting ≥4 years (n=6). One patient had carbimazole and surgery but died of hepato-renal failure secondary to systemic vasculitis. A total of 44/65 patients were managed with definitive treatment. Those needing definitive treatment had higher mean free T4 (54.6±23.7 vs. 39.5±20.5 pmol/L, p=0.02) and thyrotropin receptor antibody (TRAB) titers (34.1±19.3 vs. 13.8±9.9 IU/L p<0.0001). Long-term sequelae included need for thyroxine replacement (n=42, 64.6%), persistent goiter (12/62, 19.3%) and persistent ophthalmopathy (19/40, 47.5%).
  
  
  CONCLUSIONS
  Long-term remission rates of pediatric onset GD with ATDs are very low, especially with longer follow-up. Higher pretreatment free T4 and high TRAB titers predict need for definitive treatment.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Jevalikar
authors.forename: Julieta
authors.initials: J
authors.lastname: Solis
authors.forename: Margaret
authors.initials: M
authors.lastname: Zacharin
mesh_terms: D000293:Adolescent; D000328:Adult; D013956:Antithyroid Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000097:blood / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D008297:Male; D011379:Prognosis; D011989:Receptors, Thyrotropin / Q000276:immunology*; D012008:Recurrence; D012074:Remission Induction; D013997:Time Factors; D055815:Young Adult
chemical_list: D013956:Antithyroid Agents; D011989:Receptors, Thyrotropin