title: Severe Pediatric Thyroid Eye Disease: Surgical Case Series.
abstract: Thyroid eye disease (TED) usually has mild manifestations in pediatric patients, and orbital decompression is rarely necessarily. The authors present the clinical course of 3 pediatric patients age 16 or younger at the time of decompression surgery with severe orbitopathy. Case 1 is a 9-year-old prepubertal Asian-American female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy. Case 2 is a 14-year-old white female with Graves' disease and TED who underwent balanced decompression for compressive optic neuropathy, stretch optic neuropathy, and globe subluxation. Case 3 is a 14-year-old African-American male with unilateral euthyroid TED who underwent staged right-sided lateral, medial, and floor decompressions for asymmetric proptosis. All cases also had disfiguring proptosis and exposure keratopathy, and in all cases, surgery successfully ameliorated the indications. Children, both pre- and post-pubertal, can rarely manifest visually threatening severe orbitopathy due to TED. This represents the first reports of thyroid-related optic neuropathy and globe subluxation in pediatric patients. Further studies examining the mechanism responsible for the disparities in pediatric and adult TED are warranted.
authors.affiliation: Department of Ophthalmology and Visual Sciences, WK Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, U.S.A.
authors.forename: Chris Y
authors.initials: CY
authors.lastname: Wu
authors.forename: Victor M
authors.initials: VM
authors.lastname: Elner
authors.forename: Alon
authors.initials: A
authors.lastname: Kahana
mesh_terms: D000293:Adolescent; D002648:Child; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*