Endocrine Abstracts

Introduction: Graves’ disease (GD) is relatively rare in children. Medical therapy with carbimazole remains the mainstay of management. While longer treatment duration has been suggested to increase remission rates, evidence in the paediatric population remains limited. Our aim was to evaluate remission and relapse rates in paediatric GD and to identify factors influencing treatment outcomes.MethodsWe identified children with GD managed in our paediatric endocrine department between October 2022 and February 2025 and retrospectively reviewed their records. Those treated with carbimazole for ≥18 months were included. Data were analysed to assess variables affecting disease remission (discontinuation of carbimazole) and relapse (need to recommence carbimazole).ResultsNinety children (69% female) were included, with a mean (range) age at diagnosis of 10.7 (2.9-16.2) years. Mean (range) follow-up duration was 4.9 (2-14.1) years. Mean (range) crbimazole treatment duration was 4.3 (1.7–14.1) years; all were managed with dose-titration regime. Twenty-eight children (31.1%) achieved remission after a mean treatment duration of 3.9 years (range 1.7-9.8). Among those who achieved remission, 53.6% (15/28) experienced relapse after a mean of 12.8 months (range:5 months–2.8 years). Duration of carbimazole treatment did not predict risk of relapse (p=0.325). Eighteen percent (16/90) had definitive treatment (thyroidectomy [13/16]; radioactive iodine [3/16]) either due to non-remission after mean 5.3 years [13/16]; or relapse after remission [3/16]. No significant differences were observed between remission and non-remission groups regarding age, sex, ethnicity, duration of carbimazole treatment or TSH receptor antibody levels at presentation. Free T3 at presentation was higher in patients who did not achieve remission compared to those who did (29.1 vs. 16.1 pmol/L, p=0.035) and in those who relapsed after remission compared to those who did not (25.6 vs. 14.8 pmol/L, p=0.022).ConclusionRemission rate in paediatric Graves' disease is low. Relapse was common amongst those who initially achieved remission. In this cohort, higher free T3 at diagnosis was associated with lower remission rates and higher relapse risk, suggesting prognostic significance of the degree of T3 elevation.