Predictor of treatment outcome for pediatric Grave

Shin Do Young; Park Kyu Hyun; Eungu Kang; Hyo-Kyoung Nam; Young-Jun Rhie; Kee-Hyoung Lee

doi:10.1530/endoabs.110.P1195

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Endocrine Abstracts (2025) 110 P1195 | DOI: 10.1530/endoabs.110.P1195

ECEESPE2025 Poster Presentations Thyroid (141 abstracts)

Predictor of treatment outcome for pediatric Grave’s disease

Do Young Shin ¹ , Kyu Hyun Park ² , Eungu Kang ¹ , Hyo-Kyoung Nam ³ , Young-Jun Rhie ¹ & Kee-Hyoung Lee ⁴

Author affiliations

¹Korea University College of Medicine, Korea University Ansan Hospital, Department of Pediatrics, Ansan, South Korea; ²Nowon Eulji University Hospital, Pediatrics, Seoul, South Korea; ³Korea University College of Medicine, Korea University Guro Hospital, Department of Pediatrics, Seoul, South Korea; ⁴Korea University College of Medicine, Korea University Anam Hospital, Department of Pediatrics, Seoul, South Korea

JOINT698

Purpose: Graves’ disease (GD), the most common cause of hyperthyroidism in children, is primarily and effectively treated with Antithyroid drugs (ATDs). The aim of this study was to evaluate the factors that could predict remission, relapse, and the need for persistent high-doses of methimazole (MMI) in pediatric GD.

Methods: This is retrospective study by medical records included GD diagnosed before 19 years of age from January 2004 to December 2023. Remission was defined as maintaining the euthyroid state for more than 6months after stop ATD. The high-doses group was defined as those receiving MMI doses more than 5mg/day at last follow-up, regardless of their euthyroid status.

Results: Of the 113 patients (95 girls and 18 boys), 47(41.6%) achieved remission at a mean of 37.17±29.01 months after treatment. Compared to the non-remission group, the remission group showed significant differences in T3, fT4 and TSH-binding inhibitor immunoglobulin (TBII) at diagnosis (330.92 ± 177.72 vs 413.75 ± 179.09 ng/dl, P = 0.017; 3.31 ± 1.39 vs 4.12 ± 1.34 ng/dl, P = 0.002; 15.68 ± 14.37 vs 23.37 ± 16.61 IU/l, P = 0.012, respectively), time to TBII normalization (25.26 ± 29.88 vs 45.33 ± 37.17 months, P = 0.003), and TBII ratio at 6 months (54.98 ± 42.04 vs 87.92 ± 55.94%, P < 0.001). 11 patients (11/47, 23.4%) experienced relapse at a mean of 17.91±16.81 months after remission. Compared to non-relapse group, relapse group was predominantly male (5.6 vs 45.5%, P < 0.001) and exhibited a higher TBII ratio at 12 months (36.64 ± 33.78 vs 87.18 ± 78.14%, P = 0.025). In non-remission group, 38/66 patients (57.6%) received persistent high doses of MMI, with a mean dose of 0.39 ± 0.17mg/kg/day at the last follow-up. Compared to low-dose group, high-dose group showed significant differences in time to T3, fT4 and TBII normalization (1.21 ± 0.69 vs 2.39 ± 1.76 months, P < 0.001; 1.50 ± 0.84 vs 2.61 ± 2.47months, P = 0.013; 7.00 ± 2.61vs 9.55 ± 5.14months, P = 0.011, respectively), and TBII ratio at 6 months (61.57 ± 36.96 vs 107.34 ± 59.90%, P < 0.001). Under the ROC curve for the TBII ratio at 6 months treatment, the cut-off value of remission was 62.5%, and the cut-off value of the need for persistent high-doses of MMI was 82.5%.

Conclusion: Thyroid hormone and TBII levels at diagnosis, time to thyroid hormone and TBII normalization, and the TBII ratio after ATD treatment can be used to predict remission, relapse, and the need for persistent high-dose MMI in pediatric GD patients.