ESPE Abstracts

Background: Graves' disease is a rare autoimmune disorder in children. Its incidence is 0.1/100,000 person-years in young children and 3/100,000 person-years in adolescents. It is related to the production of TSH-stimulating autoantibodies occurring on a particular genetic predisposition. The particularity of Graves' disease in children is the risk of relapse after medical treatment, which is more frequent than in adults with a frequency of around 30%. Radio iodine treatment is a good alternative in children over 5 years old.

Aim: The aim of this study is to assess the modalities of management of Graves' disease in children and adolescents at the endocrinology department of the central hospital of Army

Method: Between 2009 and 2022, nineteen children and adolescents were treated for Graves' disease. Two patients have a history of type 1 diabetes and two children have Down syndrome. All patients underwent a clinical evaluation, an assay of Thyroid Stimulation Ultrasensitive Hormone (TSHus) and peripheral thyroid hormones. A cervical ultrasound is carried out as well as an assay of anti TSH receptor antibodies (TRAK).

Results: The average age is 11.76 years [3-18] years. The most frequent reason for consultation was cervical mass in 80%, signs of thyrotoxicosis 71.4% and exophthalmos 26.3%. TSH is slowed down and FT4 high in all patients. Thyroid stimulating immunoglobulin’s were high in 71.4% of patients. Goiter was constant; its volume exceeds 30 cc in 2 patients. All patients received initial medical treatment (Carbimazole) at an average dose of 0.84 mg / kg / day without exceeding 30 mg / day. Long-term medical treatment is the most adopted attitude in our department in 68,4% of patients with an average duration of treatment of 44 months [3-96]. Two patients underwent a total thyroidectomy and four patients receive radio iodine treatment after two relapses under medical treatment with hypothyroidism secondary to radical treatment.

Conclusion: Graves’ disease is a rare reason of consultation and admission in our department. The diagnosis was easily done in all patients. Long-term medical treatment is the most adopted attitude with general good observance and obtaining of remission in 21% of patients. Radical treatment was proposed in voluminous goiter and in case of failure of long term medical treatment.