Introduction: Anti-thyroid medications are the first line therapy for children and young people with Graves disease (GD). Some studies have shown remission rates up to 4050%; however long-term follow up studies have reported much lower remission rates in children compared to adults.
Aim: To review the long-term follow up and management of adolescents with Graves disease in a single tertiary centre in the UK.
Methods: This is a retrospective study of 37 patients with Graves disease who attended the tertiary endocrine outpatient clinic between 2007 and 2017. Patients who were excluded consisted of Hashimotos thyrotoxicosis, unclear diagnosis of Graves disease and patients with incomplete data on the system.
Results: 37 patients [M:F, 3.9:1] with Graves disease were included with a mean age of 12.16 years (S.D ± 3.3). In the sample studied, 27 (73%) received block and replace therapy (carbimazole and thyroxine) whilst 7 (19%) received carbimazole only (titration regimen). The average duration of treatment for block and replace was 30 months (range 362). The average duration of treatment for carbimazole only was 21.8 months (range 236). Out of the 27 patients who received block and replace therapy, 8 patients were still receiving ongoing treatment at the time of data collection. 14 patients had a trial off medication and the average duration of remission was 9.4 months (range 0.2521). Out of the 7 patients who received carbimazole only, 5 of them had a trial off medication and the average duration of remission was 10.3 months (range 224). In the block and replace group, only 1 out of 14 (7.1%) patients achieved remission. For carbimazole only group, one patient (out of 5, 20%) achieved remission.
Conclusion: Majority of children tend to relapse after anti-thyroid medications and require definitive treatment in the long term. Larger prospective studies are essential to understand the predictive factors for long term remission which would allow clinicians to develop criteria for medical vs surgery/radioiodine therapy.
22 - 24 Nov 2017
British Society for Paediatric Endocrinology and Diabetes