Pediatric Graves' ophthalmopathy: the pre- and postpubertal experience

Graves' disease is rare in children. The associated orbitopathy has not been well-characterized. In particular, the unique features of prepubertal Graves' orbitopathy are poorly described. In this study, we compare pre- and postpubertal Graves' orbitopathy and contrast our findings with those reported previously.

A retrospective chart review identified children with Graves' disease diagnosed clinically and serologically and treated at Children's Hospital Boston between 1996 and 2006. Pre- and postpubertal patients were segregated with the use of Tanner staging. Ophthalmic findings (including eyelid findings, proptosis, and strabismus) in the two groups were compared.

Of the 163 patients identified, 85 (52%) had some ocular signs referable to Graves' disease. Girls outnumbered boys by 7:1. Ophthalmologic consultation was obtained on only 27 patients (16%). In the prepubertal group (n = 6), 83% had lid retraction or lid lag, 50% had proptosis, and none had clinically apparent strabismus, chemosis, or preorbital fat pad enlargement. In the postpubertal group (n = 21), 86% had lid lag or lid retraction, 80% had proptosis, 5% had chemosis, 33% had preorbital fat pad enlargement, and 24% had restrictive strabismus.

Although the reported incidence of Graves' orbitopathy is 37%-67%, ophthalmology consultations were obtained on only 16% of patients treated at our institution (27 patients during a 10-year period.) Although prepubertal patients appeared to have less severe Graves' orbitopathy and absence of restrictive strabismus, the number of subjects was too small for meaningful statistical analysis.