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Remission rate and remission predictors of Graves disease in children and adolescents

Korean Journal of Pediatrics 2009;52(9):1021-1028.
Published online September 15, 2009.
Remission rate and remission predictors of Graves disease in children and adolescents
Sun Hee Lee1, Seong Yong Lee2, Hye Rim Chung3, Jae Hyun Kim1, Ji Hyun Kim1, Young Ah Lee1, Sei Won Yang1, Choong Ho Shin1
1Department of Pediatrics, College of Medicine, Seoul National University, Seoul, Korea
2Department of Pediatrics, Seoul National University Boramae Hospital, Seoul, Korea
3Department of Pediatrics, Seoul National University Bundang Hospital, Seong-Nam, Korea
소아 및 청소년 그레이브스병 환자에서의 관해 예측 인자와 관해율
이선희1, 이성용2, 정혜림3, 김재현1, 김지현1, 이영아1, 양세원1, 신충호1
1서울대학교 의과대학 소아과학교실
2보라매병원 소아청소년과
3보라매병원 소아청소년과
Correspondence: 
Choong Ho Shin, Email: chshinpd@snu.ac.kr
Abstract
Purpose
: Medical therapy is the initial treatment for children with Graves disease to avoid complications of other treatments. However, optimal treatment for childhood Graves disease is controversial because most patients require relatively long periods of medical therapy and relapse is common after medication discontinuation. Therefore, this study aimed to search clinical or biochemical characteristics that could be used as remission predictors in Graves disease.
Methods
: We retrospectively studied children diagnosed with Graves disease, treated with anti-thyroid agents, and observed for at least 3 years. Patients were categorized into remission and non-remission groups, and the groups were compared to determine the variables that were predictive of achieving remission.
Results
: Sixty-four patients were enrolled, of which 37 (57.8%) achieved remission and 27 (42.2%) could not achieve remission until the last visit. Normalization of thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) after treatment was faster in the remission group than in the non-remission group (remission group, 15.51¡¾12.07 vs. non-remission group, 41.69¡¾35.70 months). Thyrotropin-releasing hormone (TRH) stimulation tests were performed in 28 patients. Only 2 (8.3%) of 26 patients who showed normal or hyper-response in TRH stimulation test relapsed. Binary logistic regression analysis identified rapid achievement of TBII normalization after treatment as a significant predictor of remission. Six percent of patients achieved remission within 3 years and 55.8% achieved it within 6 years.
Conclusion
: Rapid achievement of TBII normalization can be a predictor of remission in childhood Graves disease. The TRH stimulation test can be a predictor of maintenance of remission.
Key Words: Graves disease, Antithyroid agents, Remission, Predictor, Childhood


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