Introduction: The majority of thyroid diseases in adults can also affect the child. Graves disease is characterized by the association of signs of hyperthyroidism and exophthalmia. It is a rare condition in pediatrics and especially affects the big child. Easy to diagnose, Graves disease in children requires strict management. We report 3 clinical cases of baseline disease, 2 of which required radical treatment.
Case 1: A 9-year-old child consults for signs of hyperthyroidism. History ans physical examination found signs of thyrotoxicosis (weight loss, tachycardia); bilateral exophthalmia, homogeneous vascular goiter. The biological assessment reveals an FT4 level of 30 ng/L; TSH at 0.09 mIU/L. Cervical ultrasound notes homogeneous diffuse thyroid hypertrophy. These clinical and para-clinical data support the diagnosis of Graves disease. The patient was put under Dimazol.
Case 2: A 10-year-old boy consults for signs of hyperthyroidism. We noted on his history and examination: signs of thyrotoxicosis (weight loss, tachycardia); bilateral exophthalmia, homogeneous vascular goiter and statural delay. The biological assessment reveals a level of FT4 at 40 pmol/L; TSH <0.05 mIU/L. The cervical ultrasound shows a homogeneous hypervascularized thyroid hypertrophy. The patient was put under Dimazol then iratherapy, patient currently presents a hypothyroidism under levothyrox.
Case 3: An 8-year-old child presented with abdominal pain, vomiting, physical asthenia, palpitations, diarrhea and weight loss for the past 6 months. On examination, his blood pressure was 100/60 mmhg, heart rate 100 bpm, a diffuse homogeneous goiter with vascular trill, a bilateral exophthalmia and lesions of vitiligo. The thyroid assessment showed a T3: 27.3 pmol/l T4l: 69.5 pmol/l TSH: 0.05 uUI/ml. The cervical ultrasound showed hypoechogenic heterogeneous thyroid, increased in size, without visible nodule with important vascularization, the patient was put on B blockers and dimazole with intolerance manifested by neutropenia at 660, the reason why the patient received iratherapy at 6mCi with good evolution.
Conclusion: Although rare in children, Graves disease remains the leading cause of hyperthyroidism in young patients. It remains easy positive diagnosis but its management may cause huge problems.
18 - 21 May 2019
European Society of Endocrinology