Extended Outcomes of Antithyroid Therapy in Children and Adolescents with Graves’ Disease

Abstract

Graves’ disease is the leading cause of hyperthyroidism in children and adolescents. Despite the widespread use of antithyroid drugs (ATDs), sustained remission rates remain low. Identifying reliable predictors of long-term outcomes is essential to optimizing management strategies. This study was conducted to evaluate the prognostic value of thyrotropin-binding inhibitory immunoglobulin (TBII) normalization time in predicting sustained remission among pediatric patients with Graves’ disease treated with ATDs. This retrospective study included pediatric patients diagnosed with Graves’ disease across two centers. Clinical, biochemical, and immunological data were collected, with particular focus on TBII dynamics during treatment. Patients were followed to assess remission, relapse, and long-term outcomes. Statistical analyses were performed to identify predictors of sustained remission. Sustained remission was achieved in approximately one quarter of patients. The most consistent predictor of remission was the time to TBII normalization, with shorter normalization periods strongly associated with favorable outcomes. Baseline demographic and biochemical features were not reliable predictors. Antibody kinetics provided superior prognostic information compared to traditional clinical markers. TBII normalization time is a robust predictor of sustained remission in pediatric Graves’ disease. Longitudinal monitoring of antibody dynamics should be integrated into routine management to guide therapeutic decisions. Patients who fail to achieve TBII normalization within two years are at high risk of treatment failure and may benefit from early consideration of definitive therapies. Incorporating antibody monitoring into follow-up protocols can improve individualized treatment planning and optimize long-term outcomes.