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Antithyroid treatment increased remission rate for children with Graves' disease
In children with Graves’ disease, antithyroid drug treatment appears to be a beneficial approach, yielding a high remission rate that continues to increase with time, according to recent findings.
In the long-term retrospective study, researchers surveyed the medical records of 1,138 patients aged 3 to 18 years who were newly diagnosed with Graves’ disease at Ito Hospital in Tokyo. The study population consisted of 995 girls and 143 boys.
All patients included for analysis were followed up for more than 1 year. Initially, all patients underwent an antithyroid drug (ATD) treatment regimen, specifically methimazole or propylthiouracil. In most study patients, the original dose of methimazole was 30 mg/day and the original dose of propylthiouracil was 300 mg/day. In other cases, the initial dose was determined based on the thyroid hormone level at the start of treatment. The dosage of ATD was sequentially decreased in a titration regimen. In cases in which normal thyroid function was maintained at a low dose for more than 6 months and TSH-receptor antibody or TSH-stimulating antibody was within the normal range, ATD treatment was stopped.
The researchers classified remission as the maintenance of normal thyroid function for more than 1 year after discontinuation of ATD, and a lack of relapses during the follow-up.
The researchers found that, of the 1,138 patients, 723 continued on an ATD regimen, 271 underwent surgical intervention or radioactive iodine therapy, and 144 dropped out of the study. Of the 723 patients who remained on ATD regimens, ATD was subsequently discontinued in 639 patients (median duration of treatment, 3.8 years; range, 0.3-24.8 years) and further continued in 84 patients. Of the 639 who stopped ATD therapy, 334 (46.2%) reached a remission, 247 (34.2%) had a relapse, and 58 (8%) dropped out of the study. The aggregate rate of remission increased with continuance of ATD treatment up to 5 years. The researchers did not identify any significant predictive factors of remission. Treatment with methimazole yielded an overall adverse event prevalence of 21.4%, and propylthiouracil was associated with an overall adverse event rate of 18.8%. No fatal adverse events were noted. The majority (91.6%) of adverse events took place within the first 3 months of ATD treatment, but 2.7% occurred more than 2 years after ATD treatment was initiated. Propylthiouracil accounted for seven of the eight late-onset adverse events.
The researchers said although these findings suggest utility of ATDs for treating children with GD, continued awareness of potential adverse events is essential.
“Vigilance is needed concerning ATD-associated adverse events throughout the ATD treatment period, and [methimazole] is a preferable ATD for long-term treatment of [Graves’ disease] in children,” the researchers wrote.
Disclosure: The researchers report no relevant financial disclosures.