ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Arch Dis Child 2018;103:637-642

Management of thyrotoxicosis in children and adolescents remains challenging and treatment varies considerably among institutions. The patient’s age, clinical status and likelihood of remission should be considered when counseling patients and parents. Nevertheless, individual prognosis of antithyroid drug treated Graves’ disease in children is highly variable and studies with data on long-term outcome are scarce. Recommendation 58 of the 2016 American Thyroid Association guidelines state that children with Graves’ disease can be treated with either methimazole or thyroidectomy at any age. Alternatively, radioiodine ablation is a further option, but not before 5 years of age, and between 5-10 years only if radioiodine activity is <10mCi.

In this retrospective study, Kourime et al. analyzed long-term outcomes in a cohort of pediatric patients with hyperthyroidism. First, they showed that the hyperthyroid phase of Hashimoto’s thyroiditis had a high remission rate, as expected from its pathophysiology. Second, they confirmed the low remission rate for Graves’ disease, with a variable time for remission, and they advocate for individualized duration of antithyroid drug treatment instead of a standard (e.g. 2 years) treatment period. These findings corroborate previous recommendations by Léger et al.^1,2 for continuous treatment, rather than treatment cycles of 2 years. Finally, the authors point out that adherence to ATD use and thyroxine replacement when needed was low, underlying the importance for initial education and counseling of families at diagnosis of thyrotoxicosis.

In the context of these remaining clinical and therapeutic problems in the treatment of pediatric Graves’ disease, results from ongoing studies using new immune modulating therapies such as TSHR-specific antibodies are awaited.

1. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA. 2016 American Thyroid Association Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid 2016:1343-1421.

2. Leger J, Gelwane G, Kaguelidou F, Benmerad M, Alberti C, French Childhood Graves’ Disease Study G. Positive impact of long-term antithyroid drug treatment on the outcome of children with Graves’ disease: national long-term cohort study. J Clin Endocrinol Metab 2012;97:110-119.

3. Leger J, Carel JC. Management of endocrine disease: arguments for the prolonged use of antithyroid drugs in children with Graves’ disease. Eur J Endocrinol 2017;177:R59-R67.