Endocrine Abstracts

JOINT914

Introduction: Graves’ disease (GD) is the most common cause of hyperthyroidism in children, however there is limited data on the epidemiology and clinical profile of GD in Bruneian children. Hence, our study aimed to describe the incidence, clinical characteristics and biochemical profile of GD in the paediatric population aged 12 years and younger in Brunei Darussalam.

Methods: A national population-based retrospective medical record review of children aged 12 years and younger diagnosed with GD was conducted from January 2017 to July 2024 in Brunei Darussalam.

Results: A total of 18 patients diagnosed with GD were included in this study, with female (77.8%) and Malay ethnicity (77.8%) predominance. The mean age at diagnosis was 8 ± 2.64 years. Frequently reported symptoms include eye symptoms (75.0%), neck swelling (66.7%), palpitations (54.5%), weight loss (37.5%), heat intolerance (30%) and diarrhoea (12.5%). Common clinical signs were goitre (88.9%), tachycardia (77.8%), fine tremors (33.3%) and hypertension (22.2%). None of the children presented in a thyroid storm while 11 patients had Graves’ orbitopathy. More than half (56.3%) had a first degree relative with thyroid disease and only 1 patient had associated Type 1 Diabetes Mellitus. All of the children had presence of Thyroid Stimulating Hormone (TSH) receptor antibody, with suppressed TSH and elevated free Thyroxine (FT4) levels. There were 17 patients (94.4%) positive for anti-thyroid peroxidase antibody and 15 patients (83.3%) positive for anti-thyroglobulin antibody. All patients were on Carbimazole with no complications but only 5 patients received additional Propanolol treatment to relieve thyrotoxic symptoms. The mean duration to FT4 normalisation from treatment initiation was 80.43 ± 52.05 days with 55.6% of the patients reported a history of non-compliance to treatment. None of the patients underwent radioactive iodine therapy or thyroidectomy. Only one patient achieved remission at the end of the study. The mean annual incidence of GD from 2017 to 2023 in children aged 12 years and younger in Brunei Darussalam was 2.9 per 100,000.

Conclusion: There is a higher incidence of GD reported in Bruneian children compared to western countries which ranges from 0.79 to 2 per 100,000. However, female predominance and major presenting symptoms were similar to other international studies on children with GD. Half the patients had history of non-compliance to treatment which may contributed to the low rate of remission. Further research is necessary to determine possible genetic or environmental factors accounting for the higher incidence of GD in Bruneian children.