ESPE Abstracts

Background: Graves’ disease (GD) is most prevalent autoimmune disorder in adult. The annual incidence in adult woman is approximately 0.5 in 1 000, and in adult men is one tenth as common as in women. GD is rare in children, with an annual incidence of 0.8 in 100 000, and with six times more common in girls, thus, GD in boys is very rare. An annual incidence of GD under 10 year-old is extremely rare. Spontaneous transient thyrotoxicosis with pregnancy is sometimes happened in 2–3% of all pregnant women. On the other hands, two adult cases of spontaneous transient Graves’ thyrotoxicosis without pregnancy were reported.

Case: A Japanese 7 month-old male infant was examined in developmental delay and poor weight gain by paediatric neurologist. Blood tests were performed, then TSH level was <0.01 μU/ml (reference value; 0.62–8.05 μU/ml), fT₄ level was 2.14 pg/ml (reference value: 0.48–2.34 pg/ml). The paediatric neurologist diagnosed him with hyperthyroidism, and reffered to our hospital at 8 month-old. Blood tests were performed. TSH level was <0.05 μU/ml, fT₄ level was 1.60 pg/mL, and fT₃ level was 5.2 pg/ml (reference value: 0.88–1.56 pg/ml), total cholesterol level was 112 mg/dl (reference value:128–219 mg/dl), thyroglobulin level was 73.6 ng/ml (reference value; 0.0–32.7 ng/ml), thyrotropin receptor antibody (TRAb) 3.9 IU/l (reference value:<1 IU/l), thyroid stimulating antibody (TSAb) 123% (reference value; <180%), anti thyroglobulin antibody (TgAb) 5.8 IU/ml (reference value; <9 IU/ml), thyroid peroxidase antibody (TPOAb) <0.1 IU/ml (reference value; <5 IU/ml). However, He was non-condition, and fT₄ level was decreased after first our examination for 1 month, and blood flow of thyroid gland in an ultrasound did not increase and technetium uptake of thyroid gland in scintigraphy was relatively increased compared to intake of salivary gland. Therefore, we decided to carry out progress observation under no treating. After 1 month, TSH level was 0.274 μU/ml, fT₄ level was 1.15 pg/ml, giving that became a normal range. fT₄ did not go up for 8 months after that and condition did not appear without treatment. We diagnosed spontaneous transient Graves’ thyrotoxicosis.

Conclusion: 7 month-old male infant with spontaneous transient Graves’ thyrotoxicosis is very rare case and show that follow-up is possible without treatment.