medwireNews: Remission is rare among children given medical treatment for Grave’s disease, although it is frequently lasting, a study shows.
“This study highlights the importance of reviewing all treatment options for hyperthyroidism with the patient and family while setting realistic expectations for therapy”, write the researchers in Clinical Endocrinology.
Perrin White (University of Texas Southwestern Medical Center, Dallas, USA) and study co-authors reviewed records of 291 children treated for Grave’s disease. The children, who had a mean age at presentation of 12 years, had a variety of ethnic backgrounds – predominantly Hispanic, Caucasian and African American – and most (79%) were female.
Twenty-three patients underwent immediate definitive therapy, in the form of thyroid ablation or surgery, while the others began treatment with an antithyroid drug – 251 with methimazole and 17 with propylthiouracil.
Of the patients started on medical treatment, 21% achieved provisional remission, defined as sustaining biochemical euthyroidism for at least 3 months after stopping treatment. This mostly occurred during the first 5.5 years of treatment, but one patient achieved remission after 11 years.
However, 28% of the 57 patients who achieved remission later relapsed, with most relapses occurring within 16 months, giving an overall lasting remission rate of 14%.
“Given the low remission rate, we believe it is entirely reasonable to offer definitive treatment with radioactive iodine upon diagnosis”, say the researchers, although they note there may be barriers to this, such as parental concerns about radioactivity and keeping children isolated from siblings during treatment.
Eventually, 57% of the patients started on medical treatment went on to receive definitive therapy, for reasons including convenience, poor control or nonadherence with medical therapy, and medication side effects.
Adverse events on methimazole were mild and occurred in 21% of patients, with the most common being rash, arthralgia, elevated transaminases and neutropenia.
“Because the reported incidence of serious adverse events with methimazole treatment is low (there were none in our case series), it remains acceptable to treat children with Grave’s disease medically”, say White and team.
By Eleanor McDermid, Senior medwireNews Reporter
Clin Endocrinol 2016; Advance online publication
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