Distinguishing Hashimoto’s thyroiditis, Graves’ disease aids paediatric thyrotoxicosis prognosis

Eleanor McDermid
Arch Dis Child 2017; Advance online publication
01 February 2018

medwireNews: Children with Hashimoto’s thyroiditis are more likely to achieve remission than those who have Graves’ disease, a long-term study shows.

Among 66 patients with thyrotoxicosis, 10 of 13 diagnosed with Hashimoto’s thyroiditis achieved remission, compared with just 10 of 53 with Graves’ disease, report Malcolm Donaldson (Royal Hospital for Sick Children, Glasgow, UK) and co-researchers.

The average follow-up duration was 11.8 years, excluding three patients lost to follow-up early, between 1.3 and 4.0 years after diagnosis. All patients with Hashimoto’s thyroiditis were female, and the Graves’ disease patients comprised 45 girls and eight boys.

All patients with long-term follow-up received antithyroid drug. Of those with Hashimoto’s thyroiditis, 12 stopped treatment for possible remission, with 10 achieving remission and two relapsing. The remaining patient stopped antithyroid drug in favour of second-line treatment because of poor control due to poor treatment adherence.

The Graves’ disease patients included 23 who stopped antithryoid drug for possible remission, with 10 achieving remission but 13 relapsing. One patient remained on antithyroid drug for the duration of follow-up and 26 stopped in favour of second-line treatment, with eight electing to do so, seven doing so because of poor control caused by nonadherence and 11 because of poor control despite reasonable adherence.

“A major problem encountered in this study is that of adherence both with [antithyroid] treatment and thyroxine replacement,” write the researchers in the Archives of Disease in Childhood, noting that poor adherence “might have been a factor” in poor disease control even when not documented.

“The culture of daily tablet-taking at the same time of day should be encouraged, and we would reinforce the need for continuing education of the patient and family in clinic,” they write.

In total, 16 patients underwent second-line surgical treatment and 22 received radioiodine treatment. Thirty-three patients were taking thyroxine replacement at the last follow-up, with poor adherence noted in 10.

Despite the long follow-up, the researchers say their findings do not offer an answer to the question of how long to keep patients on antithyroid drug before moving to second-line options. Of the 35 patients who stopped for possible remission, 23 had been taking it for more than 3 years, and over half achieved remission (13 vs 10 relapses), which was also the case for those who had been taking it for less time (seven vs five).

“Families should be warned that [antithyroid drug] treatment may be required for many years in Graves’ disease; that the number of years of [antithyroid drug] treatment cannot be predicted and that if second-line treatment such as radioiodine and surgery is given lifelong treatment with thyroxine is almost always needed”, the team concludes.

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