儿童格雷夫斯病经抗甲状腺药物治疗的长期结局。

Long-term outcomes of graves disease in children treated with anti-thyroid drugs.

机构信息

Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Pediatric Endocrinology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.

Department of Pediatric Endocrinology, MacKay Children's Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan.

出版信息

Pediatr Neonatol. 2020 Jun;61(3):311-317. doi: 10.1016/j.pedneo.2019.12.009. Epub 2020 Jan 10.

DOI:10.1016/j.pedneo.2019.12.009

PMID:31980413

Abstract

BACKGROUND

Graves disease (GD) is the most common cause of thyrotoxicosis in children and adolescents, accounting for 15% of all thyroid diseases during childhood. Anti-thyroid drugs (ATD) are recommended as the first-line treatment in children and adolescents. However, the remission rate is lower in children than in adults, and the optimal treatment duration and favorable factors associated with remission remain unknown. We aimed to investigate long-term outcomes of pediatric GD patients receiving ATD.

METHODS

We retrospectively reviewed medical charts of 396 GD subjects from 1985 to 2017 at MacKay Children's Hospital. Ninety-six patients were excluded from the analyses, including 71 patients followed for less than one year, 6 patients who received radioactive therapy and 19 patients who received surgery. The remaining 300 patients initially treated with ATD and followed up for more than 1 year constituted our study population.

RESULTS

The 300 patients comprised 257 (85.7%) females and 43 (14.3%) males. Their median age at diagnosis was 11.6 (range 2.7-17.8) years with 11 patients (3.7%) younger than 5 years. Their median follow-up period was 4.7 (range 1.1-23.9) years. Overall, 122 patients achieved the criteria for discontinuing ATD treatment, and seventy-nine (39.9%) patients achieved remission, with a median follow-up period of 5.3 (range 1.5-20.1) years. Patients in the remission group were more likely to be aged <5 years (remission vs. relapse vs. ongoing ATD; 11.4 vs. 0 vs. 2.6%, P = 0.02), less likely to have a family history of thyroid disease (24.1 vs. 42.1 vs. 52.6%, P = 0.001), and had lower TSH receptor antibody (TRAb) levels (42.8 vs. 53.6 vs. 65.1%, P = 0.02) at the time of diagnosis.

CONCLUSION

Long-term ATD remains an effective treatment option for GD in children. Pediatric GD patients aged <5 years, having no family history of thyroid disease and having initial lower TRAb levels were more likely to achieve remission.

摘要

背景

格雷夫斯病（GD）是儿童和青少年甲状腺功能亢进症最常见的病因，占儿童时期所有甲状腺疾病的 15%。抗甲状腺药物（ATD）被推荐为儿童和青少年的一线治疗方法。然而，儿童的缓解率低于成人，并且缓解的最佳治疗持续时间和有利因素仍不清楚。我们旨在研究接受 ATD 治疗的儿科 GD 患者的长期结局。

方法

我们回顾性分析了 1985 年至 2017 年麦凯儿童医院 396 例 GD 患者的病历。96 例患者被排除在分析之外，包括 71 例随访时间少于 1 年的患者、6 例接受放射性治疗的患者和 19 例接受手术的患者。其余 300 例最初接受 ATD 治疗并随访超过 1 年的患者构成了我们的研究人群。

结果

300 例患者中 257 例（85.7%）为女性，43 例（14.3%）为男性。他们的中位诊断年龄为 11.6 岁（范围 2.7-17.8 岁），其中 11 例（3.7%）患者年龄小于 5 岁。他们的中位随访时间为 4.7 年（范围 1.1-23.9 年）。总体而言，122 例患者达到停止 ATD 治疗的标准，79 例（39.9%）患者达到缓解，中位随访时间为 5.3 年（范围 1.5-20.1 年）。缓解组患者更可能年龄<5 岁（缓解组与复发组与持续 ATD 组；11.4%比 0%比 2.6%，P=0.02），更不可能有甲状腺疾病家族史（缓解组与复发组与持续 ATD 组；24.1%比 42.1%比 52.6%，P=0.001），且诊断时 TSH 受体抗体（TRAb）水平较低（缓解组与复发组与持续 ATD 组；42.8%比 53.6%比 65.1%，P=0.02）。