Graves' Disease in Prepubertal Children Compared with Pubertal Children

Kim, Hyun Mi; Yoon, Ju Yun; Jung, Min Ho; Suh, Byung Kyu; Lee, Byung Churl

Abstract

PURPOSE
The aim of this study was to determine whether differences exist in the presentation, clinical course, and outcome of Graves' disease between prepubertal children and adolescents. METHODS: A retrospective chart review of 14 prepubertal(PREPUB, 7.2+/-0.9 yr) and 38 pubertal (PUB, 12.4+/-1.5 yr) children with Graves' disease between January 1989 and November 1995 at St. Mary's Hospital and Kangnam St. Mary's Hospital was undertaken. RESULTS: There were no significant differences in T3, T4, TSH between two the groups at diagnosis. The PUB group had significantly higher titers of antimicrosomal antibody(positive dilution factor 11,727.3+/-22,888.4) than did the PREPUB group(2,111.5+/-2,285.0, P<0.001). The PREPUB group had significantly higher titers of TSH-binding inhibitory immunoglobulin(TBII, 62.5+/-39.6) than did the PUB group(44.9+/-10.4, P<0.05) before treatment started. The duration(months) of medical therapy before thyroid function tests were normalized was longer in the PREPUB group than in the PUB group(T3: 6.8+/-5.0 vs. 5.4+/-13.2, T4: 2.3+/-1.9 vs. 2.1+/-2.2, TBII: 26.7+/-24.0 vs. 20.8+/-12.1), especially that of TSH was significantly longer in the PREPUB group(14.6+/-11.0 vs. 6.8+/-7.8, P< 0.05). Total length of medical therapy was significantly longer in the PREPUB group than the PUB group(52.3+/-19.3 vs. 37.9+/-16.3 months, P<0.01). During three years of antithyroid drug therapy, in the PREPUB group, the remission rate was lower and the relapse rate was higher than in the PUB group. Total length of treatment correlated negatively with chronological age(P=0.03). CONCLUSION: Prepubertal children require longer medical therapy to achieve a remission than do pubertal children. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.