Gu Yi, Liang Xuejun, Liu Ming, Wu Di, Li Wenjing, Cao Bingyan, Li Yuchuan, Su Chang, Chen Jiajia, Gong Chunxiu
Department of Endocrinology, Genetics and Metabolism Beijing Children's Hospital Capital Medical University National Center for Children's Health Beijing China.
Pediatr Investig. 2020 Sep 27;4(3):198-203. doi: 10.1002/ped4.12219. eCollection 2020 Sep.
Graves' disease (GD) is rare in children under the age of 7 years. Children with this disease exhibit greater thyrotoxicity at diagnosis and require a longer course of medical therapy, compared with pubertal and postpubertal children and adults.
To investigate the clinical features and identify predictors of remission in children under the age of 7 years with GD.
This retrospective study included 77 children who were diagnosed with GD under the age of 7 years and were treated in the Department of Endocrinology, Beijing Children's Hospital from 2010 to 2018. Clinical manifestations, laboratory data, and follow-up records were collected for all patients. Children who achieved remission of treatment with methimazole were compared with those who had persistent disease to identify which variables were associated with remission; multiple logistic regression and Cox regression analyses were used to evaluate interactions among predictive variables.
Sixty-three boys and 14 girls were included; the median age at diagnosis was 4.2 years (interquartile range: 3.2-5.3 years). Forty-six (56.7%) patients had no family history of thyroid disease, 17 patients had family history of thyroid disease and 14 patients with unknown family history. Of the 77 patients, 18 (23.4%) patients achieved remission of treatment with methimazole and 59 patients did not; moreover, 51 (66.2%) had Graves' ophthalmopathy. Univariate analyses revealed no significant differences between the remission group and non-remission group in terms of age at diagnosis, sex, initial goiter size, or initial thyroid hormone concentration. However, there were a trend of correlation between the initial level of thyroid peroxidase antibody (TPOAb) and remission status (univariate analysis 1.002, 0.038; multivariate analysis 1.004, 0.019). Similar results were observed in univariate analysis of the initial thyrotropin receptor antibody (TRAb) level, but this association was not significant in multivariate analysis. Cox regression analyses revealed that children with high TRAb level required longer duration of remission, compared with low TRAb level ( 0.950, 95% 0.904-0.997, 0.037).
Initial TRAb level was an independent predictor of remission outcome in young children under the age of 7 years with GD. Initial TRAb level may predict the likelihood of remission in patients with young-age-of-onset GD.
格雷夫斯病（GD）在7岁以下儿童中较为罕见。与青春期及青春期后儿童和成人相比，患有这种疾病的儿童在诊断时表现出更严重的甲状腺毒症，并且需要更长疗程的药物治疗。
调查7岁以下GD患儿的临床特征并确定缓解的预测因素。
这项回顾性研究纳入了77例7岁以下被诊断为GD并于2010年至2018年在北京儿童医院内分泌科接受治疗的儿童。收集了所有患者的临床表现、实验室数据和随访记录。将使用甲巯咪唑治疗后实现缓解的儿童与疾病持续存在的儿童进行比较，以确定哪些变量与缓解相关；使用多因素逻辑回归和Cox回归分析来评估预测变量之间的相互作用。
纳入63名男孩和14名女孩；诊断时的中位年龄为4.2岁（四分位间距：3.2 - 5.3岁）。46名（56.7%）患者无甲状腺疾病家族史，17名患者有甲状腺疾病家族史，14名患者家族史不明。在这77例患者中，18例（23.4%）使用甲巯咪唑治疗后实现缓解，59例未缓解；此外，51例（66.2%）有格雷夫斯眼病。单因素分析显示，缓解组和未缓解组在诊断年龄、性别、初始甲状腺肿大小或初始甲状腺激素浓度方面无显著差异。然而，甲状腺过氧化物酶抗体（TPOAb）初始水平与缓解状态之间存在相关趋势（单因素分析P = 0.038，OR = 1.002；多因素分析P = 0.019，OR = 1.004）。促甲状腺素受体抗体（TRAb）初始水平的单因素分析也观察到类似结果，但在多因素分析中这种关联不显著。Cox回归分析显示，与TRAb水平低的儿童相比，TRAb水平高的儿童缓解持续时间更长（P = 0.037，HR = 0.950，95%CI 0.904 - 0.997）。
初始TRAb水平是7岁以下GD幼儿缓解结局的独立预测因素。初始TRAb水平可能预测发病年龄小的GD患者缓解的可能性。
