Longterm Follow-up of Children with Graves' Disease: Treatment Outcome Including Graves' Orbitopathy

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SAT 622-631-Pediatric Endocrinology: Thyroid
Saturday, June 15, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SAT-623
Lore Ligeti1, Katja Konrad*1, Anja Eckstein2, Wei-Shih Liu1, Corinna Grasemann1 and Berthold P Hauffa1
1Universitšt Duisburg - Essen, Kinderklinik II, Essen, Germany, 2Universitšt Duisburg - Essen, Essen, Germany
Aim: Retrospective analysis of pediatric patients with Graves' disease (GD) concerning treatment outcome and development of Graves’ orbitopathy (EO) in a single center. Methods: All children and adolescents presenting with GD between 1.1.1978 and 31.12.2010 (n=46) were included. Of these children, 15 (all f) were in stable remission (≥ 12 mo without clinical or laboratory signs of hyperthyroidism) after finishing antithyroid drug (ATD) therapy (remission group, RG). 16 children (13 f) had undergone ablative treatment of the thyroid (AG; n=15 surgery, n=1 radioiodine therapy). All patients with ongoing ATD therapy (OTG; n=15, 10 f) were included as a third group. The following parameters were analysed: age, auxological and thyroid parameters at disease onset, duration of treatment, exacerbations of disease activity during treatment (exacerbation: rise of ATD dose ≥ 33% with increase in fT4 ≥ 20% and/or clinical symptoms of hyperthyroidism), and the mean/cumulative ATD dose throughout treatment. Results: In the RG, BMI SDS at disease onset was higher (0.13±0.73 vs -0.8±1.21 [AG], -1.2±1.26 [OTG]; p=0.01). The number of exacerbations (0.13±0.35 [RG] vs. 1.75±1.57 [AG], 1.07±1.16 [OTG]; p=0.0008) and the cumulative ATD dose (191.9 ±160.1 mg/kg BW [RG] vs.329.7 ±152.3 mg/kg BW [AG], 322.2 ±168.9 mg/kg BW [OTG]; p=0.013) as well as the mean daily ATD dose (0.17 ±0.07 mg/kg/d vs. 0.28 ±0.09 mg/kg/d [AG], 0.26 ±0.1 mg/kg/d [OLG]; p=0.003) were lower in the RG than in the other groups, suggesting a milder course of the disease. Thyroid volume, TSH and fT4 serum concentrations at disease onset and treatment duration did not differ between groups. The majority of patients had signs/symptoms of  EO. 29.3 % of the patients had increased lid width, 66.7 % had exophthalmus, 7.3 % double vision, 9.8 % pain and 12.2 % pressure sensation. Visual loss was not reported. At examination, 38.7 % of the patients had increased and/or asymmetric lid width, 25 % had soft tissue involvement, 68.8 % exophthalmus (uni- or bilateral), and 6.3 % had motility impairment. No case of optic neuropathy was seen. The prevalence of EO did not differ between groups. Conclusion: In general, prognosis of Graves' disease is favourable in children and adolescents. EO appears to be milder than that seen in adults with main signs in children being increased lid width and exophthalmos. Poor prognosis can be recognized by high cumulative and mean dosage of ATD, and high number of exacerbations during ATD treatment.

Nothing to Disclose: LL, KK, AE, WSL, CG, BPH

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