Graves' Disease in Children: Long-term Outcomes of Medical Therapy

Shona Rabon; Amy M. Burton; Perrin C. White


Clin Endocrinol. 2016;85(4):632-635. 

In This Article

Patients and Methods


Charts of children 18 years or younger with the diagnosis of hyperthyroidism seen at Children's Medical Center Dallas from 2001 to 2011 were retrospectively reviewed under an Institutional Review Board-approved protocol at the University of Texas Southwestern Medical Center. To identify patients with Graves' disease, we searched the billing databases of Children's Medical Center for ICD9 codes 242.xx (where x is any digit).

Inclusion criteria include elevated free T4 and total T3 or free T3, with concomitant suppressed TSH, and either positive thyroid-stimulating immunoglobulin or thyroid receptor antibodies, or clinical signs suggestive of Graves' disease (e.g. tachycardia, tremor, exophthalmos). Patients with evidence on thyroid uptake scan of autonomously functioning nodules or chronic lymphocytic thyroiditis (i.e. low uptake) were excluded.

From the patients identified, we collected demographic data, clinical features at presentation, initial biochemical data, treatment methods, duration of treatments, and side effects from medical therapy. Provisional remission was defined as biochemical euthyroidism after cessation of ATD for at least 3 months. Patients in remission were considered to have relapsed if ATDs were reinstituted or the patient proceeded with definitive treatment (surgery or radioactive iodine).

Data Analysis

Kaplan–Meier survival analyses were used to estimate time to remission and to relapse. Time to provisional remission was defined as the interval from initiation to discontinuation of medication, if the patient remained euthyroid (both free T4 and TSH within reference ranges) for at least 3 months afterwards. Patients who did not experience remission were censored by either recording the last date the patient was known to be taking the medication or the date the patient underwent definitive therapy. Separate survival analyses were performed to determine whether differences in ethnicity or gender affect remission or relapse rates in patients treated with ATDs.