Introduction: Hyperthyroidism is a disorder of the thyroid function in childhood that causes symptoms such as low school performance, headache, hyperactivity, palpitation, systolic hypertension, heat intolerance, diarrhea, weight loss inspite of tremendous appetite and tremor. Hyperthyroidism is very rare in childhood. Graves disease is responsible for 84% of pediatric cases and is the most common cause.
Method: The demographic characteristics, referral complaints, physical examination findings, laboratory findings, ultrasound findings and treatments of Graves cases in Gazi University Pediatric Endocrinology Department between 19902016 were examined retrospectively.
Results: Among 24 cases diagnosed with Graves disease 87.5% (n:21) were girls and 12.5% (n:3) were boys with a mean age of 10.7 years (min 3.6 years- max 16.5 years). The most frequent complaints among the cases were palpitation (50%), followed by irritability, sweating, weight loss (41.7%) and the rarest heat intolerance. When physical examination findings were examined, 66.7% (n:16) cases of tachycardia was observed, with hypertension at 41.7% (n:10), tremor at 25% (n:6), goiter at 29.2% (n:7), and 50% (n:12) ophthalmopathy was detected. Of the cases, while 45% (n:11) was prepubertal, 54.2% (n:13) was pubertal. The comparison of symptoms of the pubertal and prepubertal according to examination and laboratory findings of the cases are given in Table 1. Thyroid ultrasonography revealed 54% (n:13) cases of goiter, with parenchymal heterogeneity at 95.8% (n:23) and parenchymal homogeneity found to be 4.2% (n:1). In all cases, 54% (n:13) of them with medical treatment were treated with block-replacement therapy, 2 patients who did not benefit from the treatment were treated with radioactive iodine and 2 other patients with surgical therapy.
Discussion: While Graves disease is common in children during pubertal period, the number of prepubertal and pubertal cases in our study were similar. The most frequent symptom was palpitation and the most common physical examination was tachycardia. Ophthalmopathy was seen in 50% of the cases. Thyroid parenchymal features were an important parameter in the differential diagnosis of hyperthyroidism. Parenchymal heterogeneity was detected in 95.8% of our cases inspite of the parenchyma is generally homogenous in thyroid ultrasonography of Graves cases.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology