ESPE Abstracts

Background: Hyperthyroidism is uncommon in children. Graves’ disease is the most common cause in pediatric population. The diagnosis is based on the presence of anti-TSH receptor antibodies. Pediatric Graves’ disease has some peculiarities mainly in term of treatment and evolution, since its prognostic is different than adults.

Aim: The aim of this study is to describe the epidemiological, clinical and biological features of pediatric Graves’ disease. We also evaluated the effectiveness of treatment and determining the risk factors of remission and relapse.

Methods: A retrospective chart review of all Pediatric Graves’ cases referred to our department during 23 years (from January 1st 1997 to December 31st 2019).

Results: A total of 25 children met diagnostic criteria. Annual incidence rate was 1,08 case per year. The average age was 9.02 +/- 3.96 years. At diagnosis, weight was decreased with median weight -0.52 +/- 1.03 standard deviation, height was increased with median height 0.36 +/- 1.36 standard deviation. 18 children had goiter, 16 had exophthalmos, 14 had tachycardia and 4 children were hypertensive. Free T4 levels were elevated in 96% cases. TSH was suppressed in all cases. TRAK results were available in 8 cases and were positive in all of them. Initial treatment was with antithyroid medication and it was started in 23 cases. We used Benzylthiouracile (BZU) in 14 cases and Thiamazole (Thi) in 9 cases. Initial mean BZU dose was 256.43 +/- 46 mg/1.73 m²/j and mean Thi dose was 0.6 +/- 0.34 mg/Kg/j. Block and replace method was used in 4 cases. Radical treatment was proposed for one girl, it consisted of surgery (total thyroidectomy). After a mean duration of follow-up of 37.81 +/- 38.79 months, long term remission was obtained in 3 cases, short term remission in 2 cases. 2 children have relapsed and 12 were lost to follow up. During treatment, 8 children presented side effects from treatment.

Conclusion: Graves’ disease treatment is cheap and safe but requires prolonged follow up.