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Triiodothyronine-predominant Graves' disease in childhood: detection and therapeutic implications.

AbstractOBJECTIVE:
To assess in a pediatric population, the clinical characteristics and management of triiodothyronine-predominant Graves' disease (T3-P-GD), a rare condition well known in adults, but not previously described in children.
DESIGN:
We conducted a university hospital-based observational study.
METHODS:
All patients with GD followed for more than 1 year between 2003 and 2013 (n=60) were included. T3-P-GD (group I) was defined as high free T3 (fT3) concentration (>8.0 pmol/l) associated with a normal free thyroxine (fT4) concentration and undetectable TSH more than 1 month after the initiation of antithyroid drug (ATD) treatment. Group II contained patients with classical GD without T3-P-GD.
RESULTS:
Eight (13%) of the patients were found to have T3-P-GD, a median of 6.3 (3.0-10.5) months after initial diagnosis (n=4) or 2.8 (2.0-11.9) months after the first relapse after treatment discontinuation (n=4). At GD diagnosis, group I patients were more likely to be younger (6.8 (4.3-11.0) vs 10.7 (7.2-13.7) years) and had more severe disease than group II patients, with higher serum TSH receptor autoantibodies (TRAb) levels: 40 (31-69) vs 17 (8-25) IU/l, P<0.04, and with slightly higher serum fT4 (92 (64-99) vs 63 (44-83) pmol/l) and fT3 (31 (30-46) vs 25 (17-31) pmol/l) concentrations. During the 3 years following T3-P-GD diagnosis, a double dose of ATD was required and median serum fT4:fT3 ratio remained lower in group I than in group II.
CONCLUSION:
Severe hyperthyroidism, with particularly high TRAb concentrations at diagnosis, may facilitate the identification of patients requiring regular serum fT3 determinations and potentially needing higher doses of ATD dosage during follow-up.
AuthorsJulie Harvengt, Priscilla Boizeau, Didier Chevenne, Delphine Zenaty, Anne Paulsen, Dominique Simon, Sophie Guilmin Crepon, Corinne Alberti, Jean-Claude Carel, Juliane Léger
JournalEuropean journal of endocrinology (Eur J Endocrinol) Vol. 172 Issue 6 Pg. 715-23 (Jun 2015) ISSN: 1479-683X [Electronic] England
PMID25766047 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
Copyright© 2015 European Society of Endocrinology.
Chemical References
  • Antithyroid Agents
  • Immunoglobulins, Thyroid-Stimulating
  • thyrotropin-binding inhibitory immunoglobulin
  • Triiodothyronine
  • Thyrotropin
  • Thyroxine
Topics
  • Adolescent
  • Age Factors
  • Antithyroid Agents (administration & dosage, pharmacology)
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Graves Disease (blood, classification, drug therapy)
  • Humans
  • Immunoglobulins, Thyroid-Stimulating (blood)
  • Male
  • Severity of Illness Index
  • Thyrotropin (blood)
  • Thyroxine (blood)
  • Treatment Outcome
  • Triiodothyronine (blood)

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