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Graves' disease in 2.5 years old girl - 6-years-long observation
Olimpia Jonak1, Joanna Połubok1, Ewa Barg2
1Student's Association of Science, Wroclaw Medical University.
Insights
Pediatric Graves' disease, a rare autoimmune condition, can be effectively treated in young children with antithyroid drugs, leading to long-term remission. Early diagnosis and management are crucial for favorable outcomes in pediatric hyperthyroidism.
Area of Science:
- Pediatric Endocrinology
- Autoimmune Diseases
- Thyroid Disorders
Background:
- Pediatric Graves' disease is uncommon in young children.
- It is more prevalent in those with a family history of autoimmune thyroid disease or existing autoimmune conditions.
- This case highlights a rare occurrence in a prepubertal child.
Purpose of the Study:
- To report a case of pediatric Graves' disease in a young child.
- To discuss the diagnosis and management of hyperthyroidism in a prepubertal patient.
- To emphasize the possibility of long-term remission with antithyroid drug therapy.
Main Methods:
- A 2.5-year-old girl presented with tachycardia and subfebrile temperature.
- Laboratory tests confirmed hyperthyroidism (low TSH, high FT3/FT4) with negative thyroid antibodies.
- Treatment involved methimazole and propranolol, followed by monitoring of thyroid function.
Main Results:
- The patient was diagnosed with Graves' disease and treated with methimazole and propranolol.
- Thyroid function normalized within one year of treatment.
- The child achieved long-term remission and is off medication at age 8, despite persistent atopy.
Conclusions:
- Tachycardia in children warrants consideration for hyperthyroidism.
- Antithyroid drug therapy can achieve long remission in young children with Graves' disease.
- Treatment should be tailored to the individual patient's age and condition.
Introduction:
Pediatric Graves' disease is rare in young children, more frequent in children with other autoimmune diseases or with family history of autoimmune thyroid disease.
Case Report:
The 2.5 year old girl was admitted to the hospital with tachycardia and subfebrile temperature. The girl presented symptoms of atopic dermatitis. Child's mother was diagnosed with Hashimoto disease two months after the child's diagnosis. In physical examination of the child, enlarged thyroid was found. At the admission, the laboratory tests revealed decreased TSH (0.001 uIU/ml), increased both FT3 (>30 pg/ml) and FT4 (3.43 ng/dl), but normal levels of anti-thyreoglobulin antibodies (ATG - 0.64 IU/ml) and anti-thyroid peroxidase antibodies (ATPO - 0 IU/ml); thyrotropin receptor antibodies (TRAb) were not identified. The Graves' disease was diagnosed. The girl started treatment with methimazole (2x5mg) and propranolol (due to tachycardia, 2x5mg). The thyroid function (TSH, FT4 and FT3) normalized 1 year after diagnosis and hormone levels remained within normal reference values, but she received methimazole for 18 months. At presen, the patient is 8 years old. She is not receiving any treatment and her thyroid function is correct. The girl still presents symptoms of atopy.
Conclusion:
In case of symptoms of tachycardia in children, the hyperthyroidism should be taken into consideration. Numerous methods of treatment provide a therapy appropriate to the age and condition of patients. Long remission after treatment with antithyroid drugs could also be achieved in younger (prepubertal) children.