Pediatric thyroid eye disease--the Singapore experience

Area of Science:

• Ophthalmology
• Endocrinology
• Pediatrics

Background:

• Thyroid eye disease (TED) is an autoimmune condition affecting the orbit.
• Pediatric TED is rare and its characteristics may differ from adult forms.
• Understanding pediatric TED demographics and clinical features is crucial for appropriate management.

Purpose of the Study:

• To characterize the demographics, risk factors, clinical presentations, and treatment of pediatric thyroid eye disease (TED).
• To analyze the specific manifestations and outcomes in a South-East Asian pediatric population.
• To compare findings with existing literature on Caucasian pediatric TED patients.

Main Methods:

• A retrospective case series was conducted.
• Data from pediatric patients (≤18 years) presenting to a tertiary TED clinic from 2006-2012 were analyzed.
• Demographics, clinical signs, disease severity, and treatment interventions were recorded.

Main Results:

• Thirteen pediatric TED patients (6.2% of all TED cases) were identified, with a median age of 10 years.
• Common signs included proptosis (92.3%), eyelid retraction (84.6%), and acquired epiblepharon (69.2%).
• Most patients had mild disease (76.9%) and were managed conservatively; no optic neuropathy or strabismus was observed.

Conclusions:

• Pediatric TED in this cohort presented with milder manifestations compared to adults.
• Conservative therapy is generally effective, with orbital decompression reserved for severe proptosis.
• Acquired epiblepharon is common in East Asian pediatric TED, necessitating increased awareness among clinicians.