Remission Rates of Children and Adolescents with Thyrotoxicosis Treated with Antithyroid Drugs

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Abstract
The clinical course of 65 children with hyperthyroidism in whom antithyroid medication was initiated has been reviewed retrospectively. Patients (55) received only this projected medical therapy with propylthiouracil or methimazole. Sustained remission in excess of 1 yr following cessation of drugs occurred in 31 patients (56%). All but 2 achieved that remission within 4.5 yr. Of the 31 patients, 24 have been followed-up for more than 2 yr off medication with only 1 relapse. Patients (24) are still under medical therapy, 14 for longer than 4.5 yr. By methods of life-table analysis, the data on all 65 patients gave an estimate of 25% remitting within the first 2 yr and a median remission time of 4-4.5 yr. These results suggest a continuing remission rate of 25% every 2 yr for up to 6 yr of follow-up. Analysis of presenting variables (assessment of age at onset of disease, sex, family history, initial laboratory data, gland size and degree of exophthalmos) that might have distinguished which patients were likely to undergo remission was attempted. There were no clearly significant differences with any of these variables although several suggestive differences emerged. These included a tendency toward earlier remission in patients older than 13 yr, in boys of any age and in patients of any age or sex in whom initial triiodothyronine (T3, RIA [radioimmunoassay]) was < 645 ng/100 ml. An approach to long-term medical management is proposed.