Clinical features and treatment of graves ophthalmopathy in pediatric patients.
OBJECTIVE
To determine the clinical characteristics and review the frequencies of medical and surgical treatment of children with Graves ophthalmopathy.


METHODS
Retrospective case series identifying patients 18 years or younger in whom Graves ophthalmopathy was diagnosed from 1985 through 1999. Data also were obtained from a follow-up survey.


RESULTS
The 35 children with Graves ophthalmopathy included 27 girls (77.1%) and 8 boys (22.9%). At the time of initial ophthalmic examination, 31 patients (88.6%) were hyperthyroid, 1 (2.9%) was hypothyroid, and 3 (8.6%) were euthyroid. The mean age at diagnosis of thyroid dysfunction was 13.1 years (range, 3 to 18). The mean age at diagnosis of ophthalmopathy was 15.0 years (range, 5 to 18). No patient had compressive optic neuropathy. Thirty-one patients (88.6%) required no therapy or only supportive therapy. One patient (2.9%) required eyelid surgery and 3 (8.6%) underwent transantral orbital decompression for proptosis that caused discomfort and exposure keratitis. No patient received systemic corticosteroids or orbital radiotherapy. A follow-up survey was returned by 20 respondents at a mean follow-up of 11.0 years after the initial examination (range, 3.4 to 19.4). One patient (5.0%) had undergone eye muscle surgery. All patients stated that their vision was good, and 19 (95.0%) had no diplopia. Two patients (10.0%) reported that family members had Graves ophthalmopathy, and 12 (60.0%) had family members with thyroid dysfunction.


CONCLUSIONS
The clinical manifestations of Graves ophthalmopathy are relatively less severe in pediatric patients. Surgical therapy is infrequently necessary.
Durairaj
Vikram D
VD
Department of Ophthalmology, Rocky Mountain Lions Eye Institute, University of Colorado, Denver, USA.
Bartley
George B
GB
Garrity
James A
JA
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed