Graves' disease in Children: A Case Report of Rare Occurrence

Area of Science:

• Pediatric Endocrinology
• Autoimmune Disorders
• Thyroidology

Background:

• Graves' disease (GD) is a rare autoimmune disorder in preschool-aged children (<5 years).
• Undiagnosed GD can lead to severe acute and long-term complications, impacting growth and development.
• This case highlights the challenges of diagnosing and managing GD in young children, particularly those from disadvantaged backgrounds.

Observation:

• A four-year-old girl presented with a six-month history of progressive thyroid enlargement and thyrotoxic symptoms.
• Clinical examination revealed goiter, thyrotoxicosis, bilateral exophthalmos, and hypertension.
• Laboratory tests confirmed Graves' disease with suppressed TSH, elevated thyroid hormones, and high TRAb levels (>40 IU/L).

Findings:

• Initial treatment with carbimazole and propranolol led to clinical improvement.
• Biochemical parameters, including TRAb levels, remained elevated at 8 months, with suppressed TSH at 13 months.
• These findings indicate a high risk of relapse, necessitating long-term antithyroid drug (ATD) therapy.

Implications:

• This case emphasizes the need for prolonged monitoring and individualized treatment plans for pediatric Graves' disease.
• Definitive treatment options like radioactive iodine (RAI) or thyroidectomy should be considered if remission is not achieved.
• Effective management requires a comprehensive approach to address the complexities of Graves' disease in young children.