title: Clinical and endocrine features and long-term outcome of Graves' disease in early childhood.
abstract: Hyperthyroidism is rare in early childhood and most commonly caused by Graves' disease. We report 14 children (4 boys, 10 girls) aged 3.4-7.5 yr. At diagnosis, all patients had weight loss, hyperkinetic activity, tachycardia, difficulty sleeping, and poor concentration and 11 presented with proptosis. Four patients developed long-term neuropsychological problems. There was a family history in 7 cases. All patients had goiters, clinically assessed to be large and diffuse in 21%, medium-sized in 43%, and small in 36%. At diagnosis, height was increased with median (range) height; 1.25 standard deviation score (SDS) (-0.2-5.24) and body mass index (BMI) was decreased; -0.48 SDS (-1.65-1.26). Height and BMI SDS values were statistically different (p<0.032) Bone age was advanced in 4 of 5 children, who had assessments. Total or free T4 levels were elevated and TSH was undetectable. Ninety percent of patients (12/14) had positive thyroid peroxidase autoantibodies, mean level 680 IU/ml (range 50-1347). Initial treatment was with antithyroid medication using carbimazole; median dose 0.75 mg/kg/day (no.=13) or propylthiouracyl 15 mg/kg/day (no.=1). T4 was added in 6 patients. Normalisation of serum T4 occurred at 4 months (1- 9) and TSH at 7 months (3-24) after start of therapy. Treatment was discontinued after a minimum of 2 yr in 11 patients, relapse occurring in 9. Median duration of total therapy was 58 months (18-132). During adolescence, 4 patients had curative therapy by surgery (no.=2) or radioiodine (no.=2). In conclusion, disturbance of growth, behavioral difficulties and infrequent spontaneous remission are key features of Graves' disease in early childhood.
authors.affiliation: Department of Paediatric Endocrinology Barts and London School of Medicine and Dentistry, London, UK.
authors.forename: A T
authors.initials: AT
authors.lastname: Bossowski
authors.forename: V
authors.initials: V
authors.lastname: Reddy
authors.forename: L A
authors.initials: LA
authors.lastname: Perry
authors.forename: L B
authors.initials: LB
authors.lastname: Johnston
authors.forename: K
authors.initials: K
authors.lastname: Banerjee
authors.forename: J C
authors.initials: JC
authors.lastname: Blair
authors.forename: M O
authors.initials: MO
authors.lastname: Savage
mesh_terms: D017668:Age of Onset; D013956:Antithyroid Agents / Q000008:administration & dosage; D001289:Attention Deficit Disorder with Hyperactivity / Q000209:etiology; D002231:Carbimazole / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000150:complications* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D006130:Growth Disorders / Q000209:etiology; D006801:Humans; D006948:Hyperkinesis / Q000209:etiology; D007453:Iodide Peroxidase / Q000276:immunology; D008297:Male; D011441:Propylthiouracil / Q000008:administration & dosage; D012008:Recurrence; D012189:Retrospective Studies; D012893:Sleep Wake Disorders / Q000209:etiology; D013610:Tachycardia / Q000209:etiology; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D015431:Weight Loss
chemical_list: D013956:Antithyroid Agents; D011441:Propylthiouracil; D002231:Carbimazole; D013972:Thyrotropin; D007453:Iodide Peroxidase; D013974:Thyroxine