Commentary on "Long-term outcomes of Graves' disease in children and adolescents receiving antithyroid drugs".

Purpose: Antithyroid drugs (ATDs) are primarily used as an initial treatment in pediatric patients with Graves' disease (GD). We aimed to investigate the long-term outcomes in pediatric GD patients receiving ATDs. Methods: Retrospective data from a single center were collected from April 2003 to July 2020. A total of 98 children and adolescents aged 2-16 years diagnosed with GD and receiving ATDs was enrolled. We investigated the factors correlated with remission by comparing children who achieved remission after 5 years and those with persistent disease. Results: The study included 76 girls (77.6%) and 22 boys (22.4%). During the 5-year follow-up period, 18 children (18.3%) maintained remission, ATDs could not be discontinued in 74 patients (75.5%), and relapse occurred in 6 patients (6.2%). The remission group had significantly lower thyroid-stimulating hormone-binding inhibitory immunoglobulin (TBII) level at diagnosis (P=0.002) and 3 months (P=0.002), 1 year (P=0.002), 2 years (P <= 0.001), 3 years (P <= 0.001), 4 years (P <= 0.001), and 5 years (P <= 0.001) after ATD treatment than did the nonremission group. The remission group also had a shorter time for TBII normalization after ATD treatment (P <= 0.001). Multiple logistic regression analysis showed that the time to TBII normalization (cutoff time=2.35 years) was related to GD remission (odds ratio, 0.596; 95% confidence interval, 0.374-0.951). Conclusion: TBII level and time to TBII normalization after ATD treatment can be used to predict remission in pediatric GD patients.