23. JUVENILE HYPERTHYROIDISM (J H): THERAPEUTIC OPTIONS ACCORDING TO THE PREDICTION OF THE EVOLUTION

At present no Laboratory test is available to predict the evolution of J H (Graves'disease). A follow ip to 2 to 14 y. was carried up in 59 patients aged 2 4/12 to 17 y. old (X ± SD: 9.4 ± 3.9). They all received antithyroid drugs as initial treatment. Thirty six patients followed for 3 to 14 y., could be reevaluated with T4, T3 and TSH and/or TRH after treatment in at least 2 ocassions: at short-term (ST: 1-2 y. post onset of treatment) and at long-term (LT:more than 3 y.; X ± 6.23 ± 3.3). Twenty three patients (64%) remained hyperthyroid (Hper) between ST and LT and 9(25%) hypo or euthyroid (Hpo/Eu) between ST and LT; only 4 (11%) changed from Hper at ST to Hpo/Eu at LT. Thus, 89% did not modify their thyroid function between ST and LT. The period of the evolution from Hper to Hpo/Eu showed two distinct populations, one with a X ± SD of 17.3 ± 3.8 months and another with X ± SD of 9.4 ± 2.5 y. It is concluded that evaluation of thyroid function at ST is useful to predict their status at LT since 90% of patients showed no variations. Since patients who changed thyroid fuction from Hper to Hpo/Eu at ST did it in X 17.3 months it is advisable to wait up to this time to select another therapeutic options. If Hper persists the possibility of I 131 administration should be considered to avoid the excessively long treatment required by the unrelenting course of this disease.