ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Pediatrics. 2019;143(5).

This randomized prospective long-term study investigated the effect of long-term (8–10 years) versus short-term (18–24 months) methimazole therapy for Graves’ disease in 56 Iranian adolescents. The primary endpoint was disease remission at 48 months after stopping methimazole.

The authors observed a significantly higher rate of ongoing remission in the long-term treatment group than in the short-term treatment group after 4 years of methimazole weaning: 88% of patients treated for at least 8 years with slowly decreasing doses were in remission compared to 33% in the short-term treatment group. There were no side effects during the long-term treatment observed.

The strength of this study are its randomized prospective design with a long follow-up. The promising results of efficacy and safety are in accordance with a recent meta-analysis of long-term anti-thyroid drugs for Graves’ diseases in adults and children with reduction of relapse of 19% and 14% of every year of anti-thyroid drug treatment in adults and children [1] and a pediatric study from 1987 [2].

However, by design, the 2 study groups differed substantially in disease duration at final follow-up (up to 8 years longer in the long-term treatment group). Furthermore, as the study cohort consisted of adolescent patients (mean age 15 years) longer treatment periods might be necessary for children diagnosed before 10 years of age to achieve comparable efficacy. Nevertheless, these data provide further evidence to offer adolescents an alternative to total thyroidectomy or radioiodine ablation in case of relapse after the standard treatment period of 2 years anti-thyroid medication.

References: 1. Azizi F, Malboosbaf R. Long-term anti-thyroid drug treatment: a systematic review and meta-analysis. Thyroid 2017;27:1223–31.

2. Lippe BM, Landaw EM, Kaplan SA. Hyperthyroidism in children treated with long term medical therapy: twenty-five percent remission every two years. J Clin Endocrinol Metab 1987;64:1241–45.