Psychiatric symptoms in children and adolescents with Graves' disease: A retrospective study and a prospective study

The relationship between Grave's disease (GD) and psychiatric symptoms is unclear in children and adolescents. Assessment of psychiatric symptoms in GD is important, especially when they occur in the absence of classic symptoms such as sweating and diffuse goiter. The present two studies aimed to assess the frequency and clinical characteristics of psychiatric symptoms in children and adolescents with GD.

Study 1 was a multicentric, retrospective study while Study 2 was a monocentric, prospective, observational study. In Study 1, the participants were 135 children and adolescents aged 4 years to 16 years in whom GD was newly diagnosed. The frequency of psychiatric symptoms was the primary outcome. In Study 2, the participants were 14 children and adolescents aged 4 years to 16 years in whom GD was clinically diagnosed. Psychiatric symptoms were evaluated using various scales, and their clinical characteristics were treated as the primary outcome.

Eighty-three participants (61%) in Study 1 and five participants (36%) in Study 2 had psychiatric symptoms. Attention-deficit/hyperactivity disorder (ADHD)-like symptoms were the most common presentation. Subjective improvement of the psychiatric symptoms began one to two months after the start of GD treatment, but objective improvement proceeded slowly in Study 2.

Psychiatric symptoms were common in children and adolescents with GD, with ADHD-like symptoms being the most common presentation. Improvement of the psychiatric symptoms did not coincide with improvement of the free thyroxine value.