Bayramoğlu Elvan, Elmaogulları Selin, Sagsak Elif, Aycan Zehra
Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Altındağ/Ankara 06020, Turkey, Phone: +90 03123056513, Fax: +90 03123170353.
Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Clinic of Pediatric Endocrinology, Altındağ/Ankara, Turkey.
J Pediatr Endocrinol Metab. 2019 Apr 24;32(4):341-346. doi: 10.1515/jpem-2018-0495.
Background The management options for Graves' disease in children are limited and there is controversy regarding optimal treatment. Remission rate with anti-thyroid drug (ATD) treatment in children is said to be lower than in adults. Definitive treatments are effective, but they often result in permanent hypothyroidism. The objective of this study was to investigate the outcome of methimazole treatment, identify significant predictors of a remission and evaluate the adverse effects of methimazole in a pediatric population of GD patients. Methods Medical records of the patients who had been diagnosed with Graves' disease were screened retrospectively. Diagnostic criteria included elevated free thyroxine (fT4) and total triiodothyronine (T3), suppressed thyroid-stimulating hormone (TSH) and either positive thyroid-stimulating immunoglobulin (TSI) or thyroid receptor antibodies (TRABs) or clinical signs suggestive of Graves' disease, for example, exophthalmos. Remission was defined as maintenance of euthyroidism for more than 12 months after discontinuing methimazole treatment. Results Of the 48 patients, provisional remission was achieved in 21 patients. Of the 21 patients, 14 experienced a relapse (66.6%). Remission was achieved in seven (24.1%) of 29 patients who received methimazole treatment for more than 2 years. In patients who achieved long-term remission, the male sex ratio and fT4 levels at diagnosis were significantly lower than the relapsed and non-remission groups, whereas the free triiodothyronine (fT3)/fT4 ratio and duration of methimazole treatment were significantly higher than the relapse group. Conclusions Long-term methimazole treatment in pediatric Graves' disease would be appropriate. High fT4 levels at the time of diagnosis and male sex were associated with a risk of relapse.
儿童Graves病的治疗选择有限，关于最佳治疗方法存在争议。据说儿童抗甲状腺药物（ATD）治疗的缓解率低于成人。确定性治疗有效，但往往会导致永久性甲状腺功能减退。本研究的目的是调查甲巯咪唑治疗的结果，确定缓解的重要预测因素，并评估甲巯咪唑在儿科Graves病患者中的不良反应。方法：回顾性筛查已诊断为Graves病患者的病历。诊断标准包括游离甲状腺素（fT4）和总三碘甲状腺原氨酸（T3）升高、促甲状腺激素（TSH）受抑制以及甲状腺刺激免疫球蛋白（TSI）或甲状腺受体抗体（TRABs）阳性或有提示Graves病的临床体征，如突眼。缓解定义为停用甲巯咪唑治疗后甲状腺功能正常维持超过12个月。结果：48例患者中，21例实现临时缓解。在这21例患者中，14例复发（66.6%）。接受甲巯咪唑治疗超过2年的29例患者中有7例（24.1%）实现缓解。在实现长期缓解的患者中，诊断时的男性比例和fT4水平显著低于复发组和未缓解组，而游离三碘甲状腺原氨酸（fT3）/fT4比值和甲巯咪唑治疗持续时间显著高于复发组。结论：儿科Graves病长期使用甲巯咪唑治疗是合适的。诊断时fT4水平高和男性与复发风险相关。
