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Letter
Graves’ disease: are we just delaying the inevitable?
  1. Chloe Stevens1,
  2. Shirley Langham2,
  3. Rakesh Amin3,
  4. Mehul Dattani3,
  5. Caroline Brain2,
  6. Catherine Peters4
  1. 1General Paediatrics Department, Harrogate District Hospital, Harrogate, North Yorkshire, UK
  2. 2Department of Paediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
  3. 3Paediatric Endocrinology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
  4. 4Department of Paediatric Endocrinology, Great Ormond Street Hospital, London, UK
  1. Correspondence to Dr Chloe Stevens; chloe.stevens15{at}nhs.net

https://doi.org/10.1136/archdischild-2024-327877

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    Paediatric Graves’ disease (GD) is caused by thyroid-stimulating hormone receptor antibody stimulation of the thyroid. The European Thyroid Association recently produced GD guidelines.1 Anti-thyroid drugs (ATD) are limited to carbimazole (methimazole), which is associated with neutropaenia. Propylthiouracil is not recommended due to the risk of irreversible hepatotoxicity.2 Remission rates are variable and frequently short-lived. Definitive management may be deferred because radioactive iodine (RIT) is not recommended under 10 years of age, and there is a limited surgical experience in younger children. Parental anxiety around definitive treatment and increasing confidence in medical management3 may prolong medical therapy further. Quality-of-life studies, although limited, suggest there is no evidence that children who undergo thyroidectomy regret it.4

    We undertook a service evaluation at Great Ormond Street Hospital (GOSH) to review the remission rate and indications for definitive or prolonged medical treatment. We searched medical records for endocrinology encounters between 2019 and 2022 with a diagnosis of GD (online supplemental figure 1). 50 patients were included (median age at diagnosis 9.7 (IQR 7.8–11.8) years). Based on physician preference, 8 patients started block (carbimazole) and replace …

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    Footnotes

    • Contributors CS and CP planned the study. CS collected and analysed the data. All authors contributed to the manuscript. CS and CP are responsible for the letter's content as guarantors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.