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Graves` Disease in Prepubertal Children Compared with Pubertal Children

Journal of the Korean Pediatric Society 2003;46(1):76-82.
Published online January 15, 2003.
Graves` Disease in Prepubertal Children Compared with Pubertal Children
Hyun Mi Kim, Ju Yun Yoon, Min Ho Jung, Byung Kyu Suh, Byung Churl Lee
Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
소아 Graves병의 임상적 고찰 : 사춘기 이전군과 사춘기군의 비교
김현미, 윤주연, 정민호, 서병규, 이병철
가톨릭대학교 의과대학 소아과학교실
Correspondence: 
Byung Kyu Suh, Email: suhbk@catholic.ac.kr
Abstract
Purpose
: The aim of this study was to determine whether differences exist in the presentation, clinical course, and outcome of Graves' disease between prepubertal children and adolescents.
Methods
: A retrospective chart review of 14 prepubertal(PREPUB, 7.2?.9 yr) and 38 pubertal (PUB, 12.4?.5 yr) children with Graves' disease between January 1989 and November 1995 at St. Mary's Hospital and Kangnam St. Mary's Hospital was undertaken.
Results
: There were no significant differences in T3, T4, TSH between two the groups at diagnosis. The PUB group had significantly higher titers of antimicrosomal antibody(positive dilution factor 11,727.3?2,888.4) than did the PREPUB group(2,111.5?,285.0, P<0.001). The PREPUB group had significantly higher titers of TSH-binding inhibitory immunoglobulin(TBII, 62.5?9.6) than did the PUB group(44.9?0.4, P<0.05) before treatment started. The duration(months) of medical therapy before thyroid function tests were normalized was longer in the PREPUB group than in the PUB group(T3 : 6.8?.0 vs. 5.4?3.2, T4 : 2.3?.9 vs. 2.1?.2, TBII : 26.7?4.0 vs. 20.8?2.1), especially that of TSH was significantly longer in the PREPUB group(14.6?1.0 vs. 6.8?.8, P< 0.05). Total length of medical therapy was significantly longer in the PREPUB group than the PUB group(52.3?9.3 vs. 37.9?6.3 months, P<0.01). During three years of antithyroid drug therapy, in the PREPUB group, the remission rate was lower and the relapse rate was higher than in the PUB group. Total length of treatment correlated negatively with chronological age(P=0.03).
Conclusion
: Prepubertal children require longer medical therapy to achieve a remission than do pubertal children. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.
Key Words: Graves' disease, Prepubertal, Pubertal children


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