Remission in pediatric Graves’ disease treated with antithyroid drug and the risk factors associated with relapse
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Purpose: To evaluate the characteristics and frequency of remission in pediatric patients with Graves’ disease (GD) treated with antithyroid drug (ATD) and to identify factors that may be associated with relapse. Methods: Medical records of patients younger than 19 years who presented to the Department of Pediatrics of Queen Elizabeth Hospital Hong Kong with newly diagnosed GD from 1st January 2007 to 31st December 2017 were retrospectively reviewed. Remission was defined as euthyroidism for 12 months or more after discontinuation of ATD treatment and no relapses during the follow-up period. Patients who successfully achieved remission were compared to those who suffered relapse. Factors that may predict occurrence of relapse after ATD treatments were studied, and their odds ratios (ORs) were calculated. Results: A total of 101 patients was included in this study. Eighty-one patients completed one course of ATD. Eighteen patients (17.8%) successfully achieved remission, and 58 patients (57.4%) experienced relapse after discontinuation of ATD. The remission group received a significantly longer course of ATD therapy than the relapse group (median, 28 months; interquartile range [IQR], 18–48 months in remission group vs. median, 21 months; IQR, 17–26; P=0.024). The OR for relapse was 0.971 (95% confidence interval [CI], 0.946–0.997) in univariate analysis and remained significant after adjustments in the multivariate regression model (OR, 0.961; 95% CI, 0.933–0.989; P=0.008). Conclusion: The remission rate in pediatric patients with GD treated with ATD was low. A longer ATD course was associated with a greater chance of remission in this population.
Abstract
Purpose: To evaluate the characteristics and frequency of remission in pediatric patients with Graves’ disease (GD) treated with antithyroid drug (ATD) and to identify factors that may be associated with relapse. Methods: Medical records of patients younger than 19 years who presented to the Department of Pediatrics of Queen Elizabeth Hospital Hong Kong with newly diagnosed GD from 1st January 2007 to 31st December 2017 were retrospectively reviewed. Remission was defined as euthyroidism for 12 months or more after discontinuation of ATD treatment and no relapses during the follow-up period. Patients who successfully achieved remission were compared to those who suffered relapse. Factors that may predict occurrence of relapse after ATD treatments were studied, and their odds ratios (ORs) were calculated. Results: A total of 101 patients was included in this study. Eighty-one patients completed one course of ATD. Eighteen patients (17.8%) successfully achieved remission, and 58 patients (57.4%) experienced relapse after discontinuation of ATD. The remission group received a significantly longer course of ATD therapy than the relapse group (median, 28 months; interquartile range [IQR], 18–48 months in remission group vs. median, 21 months; IQR, 17–26; P=0.024). The OR for relapse was 0.971 (95% confidence interval [CI], 0.946–0.997) in univariate analysis and remained significant after adjustments in the multivariate regression model (OR, 0.961; 95% CI, 0.933–0.989; P=0.008). Conclusion: The remission rate in pediatric patients with GD treated with ATD was low. A longer ATD course was associated with a greater chance of remission in this population.
참고문헌 (33)
- Srinivasan S, "Hyperthyroidism in children", Pediatr Rev, 36, pp.239~248 (2015)
- Wong GW, "Increasing incidence of childhood Graves' disease in Hong Kong : a follow-up study", Clin Endocrinol(Oxf), 54, pp.547~550 (2001)
- Léger J, "Management of endocrine disease : arguments for the prolonged use of antithyroid drugs in children with Graves' disease", Eur J Endocrinol, 177, pp.R59~R67 (2017)
- Mooij CF, "2022 European Thyroid Association Guideline for the management of pediatric Graves' disease", Eur Thyroid J, 11, pp.e210073~ (2022)
- Ross DS, "2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis", Thyroid, 26, pp.1343~1421 (2016)
- Committee on Pharmaceutical Affairs, "Guidelines for the treatment of childhood-onset Graves' disease in Japan, 2016", Clin Pediatr Endocrinol, 26, pp.29~62 (2017)
- Léger J, "Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves' disease: national longterm cohort study", J Clin Endocrinol Metab, 97, pp.110~119 (2012)
- Kaguelidou F, "Predictors of autoimmune hyperthyroidism relapse in children after discontinuation of antithyroid drug treatment", J Clin Endocrinol Metab, 93, pp.3817~3826 (2008)
- Ohye H, "Antithyroid drug treatment for graves'disease in children : a long-term retrospective study at a single institution", Thyroid, 24, pp.200~207 (2014)
- Azizi F, "Longterm methimazole therapy in juvenile Graves' disease : a randomized trial", Pediatrics, 143, pp.e20183034~ (2019)
- van Lieshout JM, "Methimazole-induced remission rates in pediatric Graves' disease : a systematic review", Eur J Endocrinol, 185, pp.219~229 (2021)
- Bayramoğlu E, "Evaluation of long-term follow-up and methimazole therapy outcomes of pediatric Graves' disease : a singlecenter experience", J Pediatr Endocrinol Metab, 32, pp.341~346 (2019)
- Tunç S, "Long-term monitoring of Graves' disease in children and adolescents : a single-center experience", Turk J Med Sci, 49, pp.464~471 (2019)
- Song A, "Long-term antithyroid drug treatment of Graves' disease in children and adolescents : a 20-year single-center experience", Front Endocrinol(Lausanne), 12, pp.687834~ (2021)
- Rabon S, "Graves' disease in children : long-term outcomes of medical therapy", Clin Endocrinol(Oxf), 85, pp.632~635 (2016)
- Glaser NS, "Predictors of early remission of hyperthyroidism in children", J Clin Endocrinol Metab, 82, pp.1719~1726 (1997)
- Léger J, "Graves' disease in children", Endocr Dev, 26, pp.171~182 (2014)
- Sosa JA, "Clinical and economic outcomes of thyroid and parathyroid surgery in children", J Clin Endocrinol Metab, 93, pp.3058~3065 (2008)
- Rivkees SA, "Controversies in the management of Graves'disease in children", J Endocrinol Invest, 39, pp.1247~1257 (2016)
- Cheetham T, "How to use thionamide anti-thyroid drug in the young-what's new?", Thyroid Res, 14, pp.18~ (2021)
- Weetman AP, "Methimazole inhibits thyroid autoantibody production by an action on accessory cells", Clin Immunol Immunopathol, 28, pp.39~45 (1983)
- Tötterman TH, "Induction of circulating activated suppressor-like T cells by methimazole therapy for Graves' disease", N Engl J Med, 316, pp.15~22 (1987)
- Wenzel KW, "Similar effects of thionamide drugs and perchlorate on thyroid-stimulating immunoglobulins in Graves' disease : evidence against an immunosuppressive action of thionamide drugs", J Clin Endocrinol Metab, 58, pp.62~69 (1984)
- Laurberg P, "Remission of Graves' disease during antithyroid drug therapy. Time to reconsider the mechanism?", Eur J Endocrinol, 155, pp.783~786 (2006)
- Volpé R, "The immunomodulatory effects of anti-thyroid drugs are mediated via actions on thyroid cells, affecting thyrocyte-immunocyte signalling : a review", Curr Pharm Des, 7, pp.451~460 (2001)
- Kourime M, "Long-term outcome of thyrotoxicosis in childhood and adolescence in the west of Scotland : the case for long-term antithyroid treatment and the importance of initial counselling", Arch Dis Child, 103, pp.637~642 (2018)
- Kaguelidou F, "Graves' disease in childhood : advances in management with antithyroid drug therapy", Horm Res, 71, pp.310~317 (2009)
- Gu Y, "Clinical features and predictors of remission in children under the age of 7 years with Graves' disease", Pediatr Investig, 4, pp.198~203 (2020)
- Gastaldi R, "Graves disease in children : thyroid-stimulating hormone receptor antibodies as remission markers", J Pediatr, 164, pp.1189~1194.e1 (2014)
- Jevalikar G, "Long-term outcomes of pediatric Graves' disease", J Pediatr Endocrinol Metab, 27, pp.1131~1136 (2014)
- El Fassi D, "Treatment of Graves' disease with rituximab specifically reduces the production of thyroid stimulating autoantibodies", Clin Immunol, 130, pp.252~258 (2009)
- Diana T, "A novel long-term Graves' disease animal model confirmed by functional thyrotropin receptor antibodies", Eur Thyroid J, 9(Suppl 1), pp.51~58 (2020)
- Pearce SHS, "Antigen-specific immunotherapy with thyrotropin receptor peptides in Graves' hyperthyroidism : a phase I study", Thyroid, 29, pp.1003~1011 (2019)