Grave's disease in a 4 years old Saudi girl; a case report

Abstract

Background: Graves' disease is rarely diagnosed in children under 5 years. It can lead to serious developmental and growth problems if it is not early diagnosed and properly managed. Case presentation: A case of 4-year-old Saudi female was presented with family history of hyperthyroidism and unremarkable past medical history. She was presented to the emergency department with on and off fever, irritability, thyroid swelling and bilateral eye protrusion with no other positive clinical findings. Her thyroid-stimulating hormone (TSH) was low (0.005 uIU/ml), and free thyroxine (T4) was normal (18.78 pmol/L). Thyroid ultrasound showed diffused enlargement of both lobes. Electrocardiogram revealed sinus tachycardia and incomplete bundle branch block. The patient was diagnosed with Graves' disease and started carbimazole and B-blocker treatment. Although it is usually a disease of older patients, Graves' disease should be considered in cases of tachycardia in children. As relapses are common in such cases, an appropriate management plan and follow up should be counted to achieve long term remission. Conclusion: Tachycardia in children should be taken seriously where hyperthyroidism to be considered. Treatment options are variable to achieve control and long-term remissions.