All issues > Volume 52(9); 2009

Original Article

Korean J Pediatr. 2009;52(9):1021-1028. Published online September 15, 2009.

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

Sun Hee SH Lee¹, Seong Yong SY Lee², Hye Rim HR Chung³, Jae Hyun JH Kim¹, Ji Hyun JH Kim¹, Young Ah YA Lee¹, Sei Won SW Yang¹, Choong Ho CH 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

Correspondence Choong Ho CH 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.

Keywords :Graves disease, Antithyroid agents, Remission, Predictor, Childhood