Thyroid autoantibodies in paediatric thyroid eye disease patients in an Australian population

This study presents the clinical features and management of paediatric TED patients in an Australian population, together with the longitudinal trend of TRAb and TSI over time.

A retrospective case series study was conducted on patients with paediatric TED between 2003 and 2023. A comprehensive dataset was collected and analysed for each case, encompassing patient demographics, clinical features and management of their TED, as well as their thyroid antibody levels over the study period.

Thirty-four patients were included, with a female preponderance. The age at diagnosis of thyroid dysfunction (mean age 12.1 years, range 3-17 years, SD ± 3.6 years) tended to slightly precede the age at diagnosis of TED (mean age 12.7 years, range 3-17 years, SD ± 3.59 years). The most common main TED symptom at presentation was prominent eyes in 25 patients (73.5%), and the most common presenting sign of TED was proptosis in 32 patients (94%). No patients had dysthyroid optic neuropathy. The majority (88%) of our paediatric TED patients had mild disease with a mean presenting VISA score of 1.76, and a CAS score of 1.71. During the follow up period, the average peak TRAb reached 44.2 IU/L (SD ± 96.94 IU/L), and over an average time period of 42.4 months, the most recent average TRAb level settled to 6.6 IU/L (SD ± 7.76 IU/L). The TSI levels also followed a downward trend over time.

Paediatric TED is rarer than adult TED with milder clinical presentations. TRAb and TSI levels in paediatric TED patients tend to follow the disease course, with a downward trend over time.