Can hyperthyroidism relapse after antithyroid drug treatment be predicted in children with Graves disease?

Abstract

This Practice Point commentary discusses the findings and clinical implications of a multicenter, prospective, observational cohort study that Kaguelidou et al. conducted, in which children with Graves disease were monitored for hyperthyroidism relapse after the discontinuation of antithyroid medication. Relapse risk was higher for children of nonwhite ethnic origin who had high serum levels of TSH receptor autoantibodies and T₄ at diagnosis. Conversely, older age at onset and longer duration of treatment with antithyroid medication were associated with lower relapse risk. Kaguelidou et al. suggest that a prognostic scoring system might aid treatment decisions; however, controversy exists concerning the treatment of children with Graves disease owing to variability in their responses to antithyroid drugs and a relative paucity of data about the risks and efficacy of definitive therapy in the very young. Here, I highlight the issues that should be considered when interpreting the results of this study, including the practicalities of offering definitive therapy to children.