Ann Pediatr Endocrinol Metab.  2014 Sep;19(3):154-158. 10.6065/apem.2014.19.3.154.

A 3-year-old girl with Graves' disease with literature review

• Ho YH
• Chung EC
• Park SA

• KMID: 2134083
• DOI: http://doi.org/10.6065/apem.2014.19.3.154

Abstract

Graves' disease, the main cause of hyperthyroidism in the pediatric age group, is very rare in children younger than 4 years old but can seriously interfere with growth and development if not recognized and treated. Here we report a case of a 3-year-old girl with Graves' disease who presented with goiter, exophthalmos, heat intolerance, and hyperactivity. At her first visit, her serum concentrations of triiodothyronine (T3) and free thyroxine (free T4) were normal, whereas that of thyroid-stimulating hormone (TSH) was decreased. Antimicrosomal antibody was 7,053.94 IU/mL, and TSH-binding inhibitory immunoglobulin was 31.62%. A thyroid scan showed diffuse enlargement with markedly increased uptake of both thyroid glands. Although T3 and free T4 levels were initially normal, she developed hyperthyroidism 3 months later. She was finally diagnosed with Graves' disease and treated with methimazole for 6 months. This is the first report of Graves' disease in children younger than 4 years old in Korea.

Keyword

Graves' disease; Hyperthyroidism; Child

MeSH Terms

Child
Child, Preschool*
Exophthalmos
Female
Goiter
Graves Disease*
Growth and Development
Hot Temperature
Humans
Hyperthyroidism
Immunoglobulins
Korea
Methimazole
Thyroid Gland
Thyrotropin
Thyroxine
Triiodothyronine
Immunoglobulins
Methimazole
Thyrotropin
Thyroxine
Triiodothyronine

Figure

• 

  Fig. 1 (A) A 3-year-old girl with Graves' disease. (A-C) Clinical features include a goiter and exophthalmos.

• 

  Fig. 2 Thyroid scan shows diffuse enlargement with markedly increased uptake of both thyroid glands.

Reference

1. Lavard L, Ranlov I, Perrild H, Andersen O, Jacobsen BB. Incidence of juvenile thyrotoxicosis in Denmark, 1982-1988. A nationwide study. Eur J Endocrinol. 1994; 130:565–568. PMID: 8205255.

2. Jaruratanasirikul S, Leethanaporn K, Sriplung H. Thyrotoxicosis in children: treatment and outcome. J Med Assoc Thai. 2006; 89:967–973. PMID: 16881428.

3. Johnsonbaugh RE, Bryan RN, Hierlwimmer R, Georges LP. Premature craniosynostosis: a common complication of juvenile thyrotoxicosis. J Pediatr. 1978; 93:188–191. PMID: 209162.

4. Park RW, Frasier SD. Hyperthyroidism under 2 years of age. Am J Dis Child. 1970; 120:157–159. PMID: 5454937.

5. Bossowski AT, Reddy V, Perry LA, Johnston LB, Banerjee K, Blair JC, et al. Clinical and endocrine features and longterm outcome of Graves' disease in early childhood. J Endocrinol Invest. 2007; 30:388–392. PMID: 17598970.

6. Segni M, Leonardi E, Mazzoncini B, Pucarelli I, Pasquino AM. Special features of Graves' disease in early childhood. Thyroid. 1999; 9:871–877. PMID: 10524565.

7. Rahman MA, Birrell G, Stewart H, Lucraft H, Cheetham TD. Successful radioiodine treatment in a 3 year old child with Graves' disease following antithyroid medication induced neutropenia. Arch Dis Child. 2003; 88:158–159. PMID: 12538324.

8. Coca Perez A, Colino Alcol E, Lopez Capape M, Alonso Blanco M, Barrio Castellanos R. Graves' disease in preschool children. An Pediatr (Barc). 2005; 63:259–262. PMID: 16219281.

9. Kubo T, Shimizu J, Furujo M, Takeuchi A, Yoshioka-Iwaso H, Eguchi N, et al. An infant case of Graves' disease with ophthalmopathy. Endocr J. 2005; 52:647–650. PMID: 16284447.

10. Karremann M, Cseke-Friedrich A, Horneff G. Coincidence of Graves' disease and Angelman syndrome in a 13 month old boy. Klin Padiatr. 2008; 220:29–31. PMID: 18293508.

11. Yalcin H, Akcora B, Balcı A. Graves disease with exophtalmia in a two-year old child. Mol Imaging Radionucl Ther. 2011; 20:111–113. PMID: 23486773.

12. Hussain M, John CM, Mohamed K, Zbaeda M, Ng SM, Chanderasekaran S, et al. Growth monitoring still has a place in selected populations of children. BMJ Case Rep. 2011; 10.1136/bcr.01.2010.2640, Mar 25 2011.

13. Satoh M, Aso K, Ikehara S, Komine Y, Saji T. A 3-year-old girl with Graves' disease with hypoglycemia following transient adrenal hyporesponsiveness. J Pediatr Endocrinol Metab. 2011; 24:1047–1050. PMID: 22308863.

14. Rivkees SA, Mattison DR. Ending propylthiouracil-induced liver failure in children. N Engl J Med. 2009; 360:1574–1575. PMID: 19357418.

15. Leger J, Carel JC. Hyperthyroidism in childhood: causes, when and how to treat. J Clin Res Pediatr Endocrinol. 2013; 5(Suppl 1):50–56. PMID: 23154161.

16. Birrell G, Cheetham T. Juvenile thyrotoxicosis; can we do better? Arch Dis Child. 2004; 89:745–750. PMID: 15269076.

17. Kim HM, Yoon JY, Jung MH, Suh BK, Lee BC. Graves' disease in prepubertal children compared with pubertal children. J Korean Pediatr Soc. 2003; 46:76–82.

18. Shulman DI, Muhar I, Jorgensen EV, Diamond FB, Bercu BB, Root AW. Autoimmune hyperthyroidism in prepubertal children and adolescents: comparison of clinical and biochemical features at diagnosis and responses to medical therapy. Thyroid. 1997; 7:755–760. PMID: 9349579.

19. Laurberg P. Remission of Graves' disease during antithyroid drug therapy. Time to reconsider the mechanism? Eur J Endocrinol. 2006; 155:783–786. PMID: 17132745.