Presentation and clinical outcome of adolescents with Graves’ disease

Abstract

Background: Only a limited number of studies have investigated the characteristics of pediatric Graves’ disease (GD). These studies include limited number of participants with varying treatment protocols, definition of remission, and follow-up duration.

Objective: This study aimed to determine the clinical characteristics, remission and relapse rates of adolescents with GD, focusing on potential predictors of remission at diagnosis in adolescents receiving antithyroid drugs (ATD).

Methods: Clinical, laboratory, and radiologic features of 19 patients (F/M:13/6) under 18 years of age, who were followed for GD from 2013 to 2025 at our hospital were retrospectively assessed. Remission was defined as sustained euthyroid state without relapse for at least 12 months after discontinuing ATD.

Results: Patients were diagnosed with GD at a median age of 15 years (IQR: 11.6-15.9). 7 (36.8%) presented with palpitation while 3 (15.8%) presented with weight loss. Tachycardia was observed in 9 (47.4%) and hypertension in 1 (5.3%). Goiter was detected in 13 (68.4%) and ophthalmopathy in 8 (42.1%). Thyroid ultrasonography revealed goiter (6.6 SDS, IQR: 3.6-10.3). 18 (94.7%) of patients had findings consistent with thyroiditis and 4 (21.1%) had thyroid nodules.

Five patients were solely treated with methimazole (MMI) while 14 received both MMI and a β-blocker. Median initial MMI dose was 0.3 mg/kg/day (0.2–0.4). Median follow-up time was 13.0 months (4.5–96.0). MMI was discontinued after a median of 38 months (20–96) at a median dose of 0.02 mg/kg/day (range, 0.02–0.03) in 8 (42.1%) of patients. GD (or thyrotoxicosis) was relapsed in 5 (62.5%) of pateints after a median of 4 months (3–22). Remission was achieved in 3 (15.7%). It was observed that patients with higher thyroid volume SDS at diagnosis tended to have a higher relapse rate. Definitive treatment methods, including radioiodine ablation (n=2) and total thyroidectomy (n=3), were performed in 26.3%, and papillary thyroid carcinoma was detected in one.

Conclusion: ATD is an effective treatment option in adolescents with GD. Thyroid volume at diagnosis may serve as a potential predictor of remission hence further studies are needed to confirm this observation. It should also be noted that thyroid nodules in children with GD may be associated with papillary thyroid carcinoma and therefore thyroid nodules warrant careful evaluation.