Key result
The median FT3/FT4 ratio was significantly higher in pediatric patients with Graves' disease compared to those with non-Graves' disease thyrotoxicosis (3.41 vs 2.92), demonstrating utility as a screening marker.
Why the study?
Graves' disease is the primary cause of pediatric thyrotoxicosis but remains difficult to differentiate from other conditions, whereas the FT3/FT4 ratio is an established indicator in adults.
Does the FT3/FT4 ratio differentiate Graves' disease from non-Graves' disease thyrotoxicosis in pediatric patients?
Observational (n=105)
Yes
Does the FT3/FT4 ratio differentiate Graves' disease from non-Graves' disease thyrotoxicosis in pediatric patients?
Absolute Event Rate: 3.41% vs 2.92%
p-value: p=<0.05
The FT3/FT4 ratio is a useful screening marker for differentiating Graves' disease from other causes of thyrotoxicosis in pediatric patients.
May support FT3/FT4 ratio screening in pediatric thyrotoxicosis; hypothesis-generating and requires prospective validation.
Graves’ disease (GD) is the most common cause of pediatric thyrotoxicosis; however, differentiating it from other conditions is challenging. A high free triiodothyronine-to-free thyroxine ratio (FT3/FT4) ratio has been established as an indicator of GD in adults. In this retrospective observational study, we aimed to investigate the utility of the FT3/FT4 ratio as a screening marker for pediatric GD by analyzing the medical records of 105 patients aged 1–18 years who presented with thyrotoxicosis at three hospitals in Japan. The participants were divided into a GD group (TSH receptor antibody >2.0 IU/L and requiring antithyroid drug for at least six months; n = 70) and a non-GD group (n = 35). The median (range) of the FT3/FT4 ratio was significantly higher in the GD group than in the non-GD group (3.41 [1.90–5.22] vs. 2.92 [1.50–4.40]; p < 0.05). Receiver operating characteristic curve analysis of the FT3/FT4 ratio revealed an area under the curve of 0.693 (95% confidence interval [CI], 0.577–0.808). At the optimal cutoff value of 2.88, the FT3/FT4 ratio demonstrated a sensitivity of 0.86 (95% CI: 0.80–0.91) and a specificity of 0.51 (95% CI: 0.39–0.62) for GD screening. These findings suggest the usefulness of the FT3/FT4 ratio as a screening marker for pediatric GD.
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Shimura et al. (2025) conducted an observational in Pediatric thyrotoxicosis (Graves' disease vs non-Graves' disease) (n=105). Graves' disease vs. Non-Graves' disease thyrotoxicosis was evaluated on Difference in the FT3/FT4 ratio between the groups (p=<0.05). The median FT3/FT4 ratio was significantly higher in pediatric patients with Graves' disease compared to those with non-Graves' disease thyrotoxicosis (3.41 vs 2.92), demonstrating utility as a screening marker.
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