Factors at onset predictive of lasting remission in pediatric patients with Graves' disease followed for at least three years

Seventeen pediatric patients (mean age at diagnosis 10 yr and 9 mo +/- 2 yr and 9 mo) with Graves' disease treated with 0.3-0.7 mg/kg/day methimazole and followed for at least three years, during which drug suspension was att empted on attainment of good clinical and metabolic compensation, were retr ospectively studied to look for factors predictive of lasting remission pre sent at onset. Lasting remission was defined as a clinical and laboratory p icture of euthyroidism lasting at least one year in the absence of treatmen t at the end of the follow-up. A distinction was drawn between patients who reached remission after one or two courses (groups 1 and 2) and those who never attained a lasting remission (group 3), TRAb (TBIAb) levels at onset were the only factor significantly correlated with the response to treatmen t. Age at diagnosis, goiter size and fT(3) and fT(4) concentrations were no t significantly correlated with the clinical picture. The series was too sm all to allow any assessment of the real importance of these factors, though a generally better response was displayed by children over 11 years old, w ithout appreciable or with very small goiter and moderately increased thyro id hormone levels at onset (fT(3) < 25 pg/ml in 10/10 in groups 1 and 2 and 2/7 in group 3 patients; fT(4) < 40 pg/ml in 7/10 in groups 1 and 2 and 3/ 7 in group 3 patients), It was also found that better results were obtained when the initial drug course was protracted for at least two years.