Volume 2015 Supplement 1

Abstracts from the 8th APPES Biennial Scientific Meeting

Open Access

Graves’ disease in children less than 8 years of age: review of clinical features and treatment outcome

  • Sophy Korula1,
  • Shubha Srinivasan1,
  • Geoffrey Ambler1,
  • Martin Silink1,
  • Neville Howard1,
  • Chris Cowell1,
  • Paul Benitez-Aguirre1,
  • Maria Craig1 and
  • Kim Donaghue1
International Journal of Pediatric Endocrinology20152015(Suppl 1):P102

https://doi.org/10.1186/1687-9856-2015-S1-P102

Published: 28 April 2015

Background

Graves’ disease is the most common cause of thyrotoxicosis in children. Prepubertal children are the most difficult to treat with remission attained in less than 15% [1, 2].

Objective: To characterise clinical features and review treatment outcome among children with very early onset Graves’.

Methodology

Retrospective medical record review of patients diagnosed with Graves’ disease at age less than 8 years, who received treatment in our department in the last 14 years.

Results

Sixteen patients (2 males) were identified with median age at diagnosis of 4.96 years (range 2.5-7.83). Presenting symptoms were hyperactivity, weight loss, poor sleep and diarrhoea. They had predominant non-Anglo-Saxon ethnicity. Significant co-morbidities were- Down syndrome [1], juvenile idiopathic arthritis [1], situs inversus with extrahepatic biliary atresia ie EHBA [1].Two had family history of Graves’ disease. All had goitre, increased serum Free T4 (median 53.65 pmol/l, range 35-94), increased serum Free T3 (median 33.5 pmol/l, range 19.3-46) and suppressed TSH levels. All were positive for TSII (thyroid stimulating immunoglobulin) or TRAb (thyrotropin receptor antibody). Anti thyroid peroxidise was positive in 83.3% (10/12) and anti thyroglobulin in 80% (8/10). Anti-thyroid drugs (ATD) alone were used in 9 patients, 4 received one dose each of radio-active iodine ablation (10-15 mCi) and 3 underwent thyroidectomy. Our cohort tolerated the ATD’s well- Only 1 had significant liver enzyme elevation (underlying EHBA) after Neomercazole, minor side-effects were: skin rash (3) and arthralgia [1]. Data from patients with more than 30 months follow-up was used to assess outcome. Twelve children with median follow up of 66 months (range: 34-161) and median age of 10.13 years (range: 7.17-16) at last clinic visit qualified. Remission was attained in 58.3% (7/12) - 3 were post thyroidectomy, 1 post radio-active iodine ablation and 3 received only ATD’s. Growth monitoring showed decline in median weight sds from 0.41 at diagnosis to 0.29 at follow up and height sds from 1.35 to 0.69. Of the sixteen patients 2 girls were followed through their puberty till 16 years of age and both are in remission (1 underwent thyroidectomy and other received Neomercazole).

Conclusion

Our cohort had 16 patients diagnosed with Graves’ at a median age of 4.96 years. Overall remission for those with more than 30 months follow-up is 58.3% (7/12), at a median age of 10.13 years. Thyroidectomy had a remission rate of 100%, ATD’s alone of 33.3% and one dose of radioactive iodine ablation of 25%.

Authors’ Affiliations

(1)
Institute of Diabetes and Endocrinology, The Children’s Hospital, Westmead

References

  1. Shulman DI, Muhar I, Jorgensen EV, Diamond FB, Bercu BB, Root AW: Autoimmune hyperthyroidism in prepubertal children and adolescents: comparison of clinical and biochemical features at diagnosis and responses to medical therapy. Thyroid. 1997, 7: 755-760. 10.1089/thy.1997.7.755.View ArticlePubMedGoogle Scholar
  2. Lazar L, Kalter-Leibovici O, Pertzelan A, Weintrob N, Josefsberg Z, Phillip M: Thyrotoxicosis in prepubertal children compared with pubertal and postpubertal patients. J Clin Endocrinol Metab. 2000, 85: 3678-3682. 10.1210/jcem.85.10.6922.View ArticlePubMedGoogle Scholar

Copyright

© Korula et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Advertisement