Pediatric graves' orbitopathy: a case series of 136 Chinese patients

To determine the clinical features and treatment methods of pediatric patients with Graves' orbitopathy (GO).

We analyzed 136 GO patients aged 18 or younger at West China Hospital from January 2009 to November 2023, recording symptoms, clinical characteristics, treatments, and prognosis.

Patients' ages ranged from 2 to 17 years, with 83.82% being female, mostly at Tanner stage four. Initially, 86.03% had hyperthyroidism. The most common symptom was exophthalmos (90.44%), and the main signs were lid lag (90.46%), eyelid swelling (59.75%), and upper eyelid retraction (53.11%). Females had more exophthalmos and lid lag (p = 0.010, 0.015; t = 2.620, 4.238). Imaging showed 46.97% had no extraocular muscle affected. The most affected muscles were the inferior rectus (44.7%), superior rectus (28.03%), medial rectus (21.21%), and lateral rectus (20.45%). Only six eyes were at the active stage, 65.56% had mild severity, and none were sight-threatening. No treatment was given to 51.87% of patients, while 41.49% received periorbital corticosteroid injections. Two patients had injections plus radiotherapy, and one had injections, radiotherapy, and glucocorticoid pulse therapy. Severity and activity decreased significantly in the treatment group (p < 0.001), while non-treatment group exhibited a significant decrease in severity (p = 0.022).

Pediatric GO patients, mainly late-stage pubertal females, had less severe symptoms and better prognoses than adults. Observation is often sufficient, with periorbital corticosteroid injections being effective when necessary.