Long-term outcomes in children and young adults with graves

Klara Gewert; Ruzan Udumyan; Gabriel Sjolin; Mikael Lantz; Helena Filipsson Nystrom; Selwan Khamisi; Mats Holmberg; Jan Calissendorff; Bengt Hallengren; Goran Wallin; Tereza Planck

doi:10.1530/endoabs.99.P568

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Endocrine Abstracts (2024) 99 P568 | DOI: 10.1530/endoabs.99.P568

ECE2024 Poster Presentations Thyroid (58 abstracts)

Long-term outcomes in children and young adults with graves’ disease

Klara Gewert ¹ , Ruzan Udumyan ² , Gabriel Sjölin ³ , Mikael Lantz ⁴ , Helena Filipsson Nyström ⁵ , Selwan Khamisi ⁶ , Mats Holmberg ⁷ , Jan Calissendorff ⁸ , Bengt Hallengren ⁴ , Göran Wallin ³ & Tereza Planck ⁴

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¹Lund University, Department of Clinical Sciences, Lund, Sweden; ²Örebro University, Clinical Epidemiology and Biostatistics, Department of Medical Sciences, Faculty of Medicine and Health, Örebro, Sweden; ³Örebro University, Faculty of Medicine and Health, Örebro, Sweden; ⁴Lund University, Department of Clinical Sciences, Lund, Sweden; ⁵University of Gothenburg, Sahlgrenska Academy, Department of Medicine, Gothenburg, Sweden; ⁶Uppsala University, Department of Medical Sciences, Uppsala, Sweden; ⁷Karolinska Institutet, Department of Medicine, Huddinge, Stockholm, Sweden; ⁸Karolinska Institutet, Department of Molecular Medicine and Surgery, Stockholm, Sweden

Introduction: Graves’ disease (GD) can negatively affect the quality of life. Research on GD in childhood, accounting for 1-5% of cases, has so far predominantly focused on treatment results. There is limited knowledge about association with other diseases and long-term psychosocial effects.

Aims: We aimed to compare disease burden and psychosocial outcomes between childhood/young adult GD patients and unexposed population controls.

Methods: This was a retrospective, matched cohort study using prospectively collected data from medical records and multiple Swedish registers. GD patients aged <21 years (n=87, of whom 55 were <18 years) were selected from an incidence study cohort including patients with newly diagnosed hyperthyroidism in 2003-2005 across 13 Swedish centres (n=2916). Each GD patient was matched through Statistics Sweden with ten population controls without GD (n=29160) based on age, sex, and county. The matched cohort was followed until December 31, 2019. Information on primary diagnoses, hospitalizations, education, sick leave, disability pension, and number of own children was collected. Results of a 10-year follow-up analysis are being presented here.

Results: Patients with GD exhibited a significantly higher incidence of ‘endocrine, nutritional, and metabolic diseases’ (ICD-10 E00-E90, excluding E05.0) with a hazard ratio (HR) of 19.7 ([10.7, 36.6], P<0.001) and ‘diseases of the digestive system diseases’ (ICD-10 K00-K95) with a HR of 7.39 ([1.7, 33.0], P=0.009) compared to matched population controls. Additionally, patients with GD had an increased risk of having two or more primary diagnoses besides GD (relative risk [RR]=4.4 [2.4, 7.8], P<0.001), more than three days of hospitalization (RR=5.5 [2.7, 10.9], P<0.001), over 60 consecutive days of sick leave (RR=2.1 [1.1, 3.9], P=0.016), and receiving disability pension (RR=4.2 [2.3, 7.8], P<0.001) compared to controls. Furthermore, patients with GD were more likely to only have completed compulsory education by the age of 30 (RR=2.5 [1.1, 5.8], P=0.029). No statistically significant differences were observed regarding other ICD categories or number of own children.

Conclusion: In conclusion, childhood/early adulthood GD leads to increased long-term morbidity, healthcare needs, and socioeconomic challenges, marked by more hospitalizations, sick leaves, disability pensions, and lower educational levels. These results highlight GD’s status as a chronic condition, emphasizing the need for more research to reduce its long-term effects.