Clinical features of pediatric Graves' orbitopathy

Pediatric Graves' orbitopathy is rare, thus its clinical picture is less well defined in comparison with the adult population. Therefore it is our aim to describe the clinical spectrum at our tertiary referral center. We identified 11 patients under the age of 18 years (3♂, 8♀; range 3-16 years, mean age 14.5 years) with Graves' disease and signs of orbitopathy. Seven of them where reevaluated (mean follow-up 25 months, range 3-66 months). Eyelid retraction and proptosis were the predominant signs in 10/11 of our patients. In six patients, Hertel readings ranged from 22 mm or above. Mild ocular motility impairment was seen in four children. Active orbitopathy or severe impairment of visual acuity/ocular motility, corneal or optic nerve involvement was not observed in our study. Our series confirms that pediatric Graves' orbitopathy lacks significant inflammatory features; however, proptosis is common and may be marked. All seven patients who were reevaluated did not show any clinically significant change of ocular signs during the observation period. In particular, there was no improvement of proptosis despite restoration of euthyroidism.