An infant case of Graves' disease with ophthalmopathy.
Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed exophthalmos, goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral proptosis, eyelid erythema, lacrimation, entropion of the lower eyelid, and superficial keratitis. Her serum concentrations of free thyroxine and free triiodothyronine were high, and thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for antibodies to TSH receptor (TRAb) and thyroid-stimulating antibody (TSAb). Although hyperthyroidism was controlled with propylthiouracil within 3 weeks, her eye signs did not improve. We administered methylprednisolone pulse therapy for ophthalmopathy, but the effect was limited and the lacrimation due to entropion and superficial keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the clinical course. Therefore, TRAb or TSAb might be good indicators of progress of Graves' ophthalmopathy. Ocular manifestations of Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.
Kubo
Toshihide
T
Department of Pediatrics, National Hospital Organization, Okayama Medical Center, Japan.
Shimizu
Junya
J
Furujo
Mahoko
M
Takeuchi
Akihito
A
Yoshioka-Iwaso
Haruna
H
Eguchi
Naohiko
N
Fukuhara
Shinichi
S
Koyama
Teruhisa
T
Kanadani
Tomohisa
T
Shiraga
Hiroshi
H
Oshima
Koh-ichi
K
D002675:Child, Preschool; D004774:Entropion / Q000503:physiopathology; D005260:Female; D049970:Graves Ophthalmopathy / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008775:Methylprednisolone / Q000627:therapeutic use*; D013666:Tears / Q000378:metabolism
D008775:Methylprednisolone