title: Persistent remission of Graves` disease or evolution from Graves' disease to Hashimoto's thyroiditis in childhood - a report of 6 cases and clinical implications.
abstract: BACKGROUND
  The main clinical manifestations of autoimmune thyroid diseases are Graves' disease (GD) and Hashimoto's thyroiditis (HT). Graves' disease is the cause of most cases of hyperthyroidism in childhood. Indications for radical therapy (surgery or 131I treatment) in children are still a matter of discussion, as sustained (sometimes very long) remission of GD is possible, while the radical therapy almost always leads to hypothyroidism. Spontaneous evolution from GD with hyperthyroidism to HT with hypothyroidism may also be observed.
  
  
  OBJECTIVE
  The aim of the study was to analyze the clinical course of 6 cases of hyperthyroid girls with GD in whom a normalization of previously increased autoantibodies against thyrotropin (TSH) receptor (anti-TSHR) was observed together with a significant increase in autoantibodies against thyroid peroxidase (anti-TPO) and thyroglobulin (anti-Tg), with concomitant hypo- or euthyroidism but no recurrence of hyperthyroidism.
  
  
  METHODS
  Patients' age at diagnosis ranged from 5.0 to 16.5 years. Two (2) patients had Turner syndrome, another one (1), diabetic, was on insulin therapy.
  
  
  RESULTS
  In all the girls, antithyroid drugs were administered and euthyroid state was achieved during the first 2.0-3.5 months of the treatment. Mild side effects were observed in only one case. The therapy was continued up to 1.5-4.0 years. Relapses during the therapy were observed in 2 cases. Up to now, no relapses have been observed for 0.5-7.5 years since the therapy withdrawal in 5 patients (1 patient was lost to follow-up), 2 patients are currently treated with levothyroxine due to hypothyroidism.
  
  
  CONCLUSIONS
  It seems that the prolonged pharmacotherapy with antithyroid drugs, followed by observation after remission of hyperthyroidism, may be an appropriate therapeutic option at least in some children with GD as they can be cured without radical therapy and the potential risks of such treatment.
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
authors.forename: Joanna
authors.initials: J
authors.lastname: Smyczńyska
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Cyniak-Magierska
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Stasiak
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Karbownik-Lewińska
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lewiński
mesh_terms: D000293:Adolescent; D013956:Antithyroid Agents / Q000008:administration & dosage* / Q000009:adverse effects; D001323:Autoantibodies / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006111:Graves Disease / Q000188:drug therapy* / Q000276:immunology; D050031:Hashimoto Disease / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced; D008297:Male; D008713:Methimazole / Q000008:administration & dosage / Q000009:adverse effects; D011441:Propylthiouracil / Q000008:administration & dosage / Q000009:adverse effects; D011989:Receptors, Thyrotropin / Q000276:immunology; D012074:Remission Induction; D013972:Thyrotropin / Q000276:immunology
chemical_list: D013956:Antithyroid Agents; D001323:Autoantibodies; D011989:Receptors, Thyrotropin; D008713:Methimazole; D011441:Propylthiouracil; D013972:Thyrotropin