Graves-Basedow disease in pediatric age: description of the clinical features and predictive factors for disease outcome in a single third-level center in the period 2000-2020 and review of the literature

Background: Graves-Basedow disease (GD) is a rare disease in pediatric age and its management is still controversial. Age, goiter size, fT4 and fT3 levels, TRAb titration and the duration of antithyroid drug (ATD) were considered predictors of remission. Methods: The aim of this retrospective study was to analyze the clinical features at onset of GD and the outcome of the disease in a single-center pediatric cohort. Results: Of the 55 subjects analyzed, 16 had remission of GD (group A: 29.1%), 7 underwent definitive treatment (group B: 12.7%), 27 are still on long-term ATD treatment (group C: 49.1%). The relapse rate was 37.5% reducing the overall remission rate to 18.2% with remission plateau observed after approximately 5 years of medical treatment. Serum fT3 levels at diagnosis were higher in group B (17.9±4.02 pg/mL) and group C (12.99±1.21 pg/mL) than in group A (10.79±1.09 pg/mL, P=0.03). The titer of TRAb at diagnosis was also higher in group B and C (24.03±11.45 and 22.23±11.95 UI/respectively) compared to subjects in group A (19.7±7.1 pg/mL, P=0.04) as well as thyroid volume (3.56±0.68 vs. 2.6±0.25 vs. 2.04±0.18, P=0.02). The ATD dose at diagnosis was similar in the 3 groups but significantly lower in the group A at 6, 12 and 24 months (P=0.005, P<0.005 and P<0.005 respectively). Conclusions: Given the low remission rate in GD, in presence of negative prognostic factors for remission or when the thyrotoxic state persists or when remission does not occur in approximately 5 years, definitive approach might be considered.