ESPE Abstracts

Introduction: /Purpose: Graves' disease is the most common cause of hyperthyroidism in children and adolescents. It is an autoimmune disorder characterized by stimulating autoantibodies, leading to increased thyroid hormone release and thyrotoxicosis. Early initiation and long-term treatment, remission, and definitive treatment with thyroidectomy or radioactive iodine present a challenge. This study aims to record the data of patients with Graves' disease followed in our Division over the last decade.

Methods: Patients under 16 years old with Graves' disease who were followed in the Division of Endocrinology, Diabetes and Metabolism between 2014 and 2024 were enrolled. Data regarding demographics, laboratory and imaging tests, and treatment were retrospectively collected.

Results: Twenty-one patients, aged 1.5 to 14 years old, were included. The mean age at diagnosis was 9 years, while 42% of the patients were older than 12 years. The majority were girls (76% vs. 24%). Regarding BMI z-score, 86% had normal weight, 9% were underweight, and 5% were obese. 62% were from Attica, 20% from Greek islands, 9% from the rest of Greece, and 9% from Asian-Arab countries. Seasonal distribution was confirmed with 85% of the cases diagnosed in spring/summer. 95% had no history of autoimmunity, while 67% had a positive family history of thyroid disease (65% maternal Hashimoto's thyroiditis). 5% had autoimmunity within the family (psoriasis, vitiligo). Clinical manifestations included exophthalmos (20%), goiter (90%), and palpitations-tremors-sweating (63%). Positive antibodies (TSI-TRAb) were found in 86%. Thyroid ultrasound revealed increased size (62%), heterogeneity (90%) and nodules (38%), 10% of which required further investigation with scintigraphy and fine-needle biopsy. Treatment with carbimazole was initiated at a dose of 0.25-0.5 mg/kg/d for mild-moderate disease (76%), 0.5-0.75 mg/kg/d for severe disease (14%), and <0.25 mg/kg/d (10%) for very mild disease. Additionally, a beta-adrenergic blocker was administered to 62% of the patients. Adverse effects included rash (5%) and leukopenia/neutropenia (10%). 70% of the patients restored euthyroidism within 4-6 months. An increase in BMI (>2 kg/m2) was observed in 53% of the patients after one year of treatment. Recurrence was recorded in 14% of cases within the first year of treatment. Medication continued for most patients without significant side effects. Thyroidectomy was considered in 14% of patients treated for over 3 years.

Conclusion: Our study confirms the specific characteristics of the disease in terms of gender, age, seasonal distribution, severity, and response to treatment in pediatric patients.