Background: Graves disease is the most common cause of hyperthyroidism or thyrotoxicosis in children. The prevalance is 1 in 10 000 among children. It is important to reinforce the awareness amongst clinicians as patients can present with wide range of clinical symptoms. The range of presentations in our study included a child treated for one year for Attention Deficit Hyperactivity Disorder (ADHD) to a child who had diarrhoea and abdominal pain and presented as appendicitis initially.
Methods: Retrospective review of notes and clinic letters of 15 patients who presented as hyperthyroidism in last 6 years (20132019). Inpatient and outpatient notes along with lab results were used for data analysis.
Results: 11/15 patients were confirmed to have Graves disease. 2 patients had false elevation due to Assay Interference. 1 had Hashimoto Thyroiditis and 1 had hyperthyroidism diagnosed on annual review of coeliacs disease. Age at diagnosis of our cohort ranged between 4 and 15 years, with age of 1114 years for children with Graves. 9/11 children with Graves disease were clinically thyrotoxic and required beta blockers, 5/11 had eye signs at presentation. Thyroid stimulating immunoglobulins (TSI) or TSH receptor Antibodies (TRAB) were used for confirmation of Graves. Ultrasound Scans were done in cases of Graves disease which confirmed Thyroiditis. They were normal in Hashimotos thyroiditis. Antithyroid medications (ATM) were started initially on 13/15 patients.1-not started due to assay interference and the other was clinically and biochemically euthyroid. 3/11 had definitive treatment, 1 patient underwent total thyroidectomy and 2 had radioiodine ablation. 6/11 children are having ongoing dose titration with carbimazole and 2 children currently on block and replacement. Tertiary referral was done in 11/15 cases.
Conclusion: We have relatively large group of patients with Graves Disease for our population. Patient presentation was mostly with typical symptoms and signs but was nonspecific in few others leading to a delay in diagnosis. Most of our patients are treated with Dose titration (DT) regime.Emerging evidence suggests that longer treatment on ATM might increase chance of remission.One of our patients who underwent thyroidectomy had in situ papillary carcinoma.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes