Graves’ disease: developments in first-line antithyroid drugs in the young

ABSTRACT

Introduction: First-line treatment for most young people with Graves’ disease (GD) will include the administration of a thionamide antithyroid medication (ATD); Carbimazole (CBZ), Methimazole (MMZ), or rarely, propylthiouracil (PTU). GD is a challenge for families and clinicians because the likelihood of remission following a course of ATD is lower in young people when compared to adults, yet the risk of adverse events is higher. An overall consensus regarding the optimal ATD treatment regimen is lacking; how ATD are prescribed, for how long and how the associated risk of adverse events is managed varies between clinicians, units and nations. This partly reflects clinician and family uncertainty regarding outcomes.

Areas covered: This review will focus on some of the key articles published in the field of thionamide ATD in children. It will highlight key issues that need to be discussed with families as well as addressing the approach and controversies in the treatment of GD. This article does not reflect a formal systematic review of the literature.

Expert opinion: New strategies in areas such as immunomodulation may see the development of new antithyroid drug treatments that, either in isolation or in combination with thionamide therapy, may increase the likelihood of long-term remission.

KEYWORDS:

• Antithyroid
• carbimazole
• Graves’ disease
• methimazole
• propylthiouracil
• pediatric

Article Highlights

• Graves’ disease is relatively rare in children, but is an important diagnosis to make because of the profound impact on education and well-being that can be observed.

• Three quarters of children who take antithyroid drugs to treat their Graves’ disease will relapse, although this figure may fall to one half following a lengthy treatment course lasting many years.

• Treatment of Graves’ disease with antithyroid drugs should involve counselling of the patient and their family with regards to the advantages and disadvantages of treatment modalities and their potential long-term outcomes.

• Although the optimal ATD treatment regimen is not established, current evidence suggests a better safety profile and efficacy for children using long-term, dose titrated ATD.

• The development of novel therapies to improve the treatment of Graves’ disease in children is essential.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by The Medical Research Council (MRC) [Grant number MR/S001611/1].