Retrospective Review of Pediatric Thyroid Eye Disease Cases Referred to Nicklaus Children's Hospital

Moises Enghelberg,Alice Wong,Zenia P Aguilera,Roberto Warman

doi:10.15234/vpa.v17i3.478

Abstract

Purpose: We evaluate presenting features of pediatric thyroid eye disease, and discuss the morbidity and clinical course of this condition in the pediatric population. Methods: A retrospective chart review of 11 patients referred for evaluation of thyroid eye disease at a pediatric tertiary care facility in Miami, Florida.Results: The average age at presentation was 12.7 years. The most common ocular complaint was mild irritation. Patients tended to be positive for thyroid stimulating immunoglobulin and thyroid peroxidase antibody. The average displacement on Hertel exophthalmometry was 21mm for the right eye, and 21.45mm for the left eye. Lower scleral show was the most common eyelid finding. Conclusion: In contrast to thyroid eye disease in adults, the condition tends to present with mild ocular findings in children. Pediatric patients presenting with thyroid eye disease respond very well to medical therapy aimed at enhancing the altered ocular surface.

Highlights

Less common in children than it is in adults, thyroid eye disease (TED) occurs in 0.79 to 6.5 per 100,000 children annually, with greater frequency in females, in those with concurrent autoimmune disorders or with a family history of autoimmune thyroid disease, and in those of Chinese ancestry.[1,2,3] As in adults, TED is most often associated with acquired hyperthyroidism, but may occur in hypothyroid and euthyroid states as well.[4]
Common manifestations noted in the literature include upper eyelid retraction, proptosis, eyelid lag, pain, foreign body sensation, photosensitivity, tearing, and diplopia, while optic neuropathy and corneal breakdown are infrequent.[4]
We identified a total of 55 patients with Graves’ disease who had been examined by the endocrinology team in the last decade

Summary

Introduction

Less common in children than it is in adults, thyroid eye disease (TED) occurs in 0.79 to 6.5 per 100,000 children annually, with greater frequency in females, in those with concurrent autoimmune disorders or with a family history of autoimmune thyroid disease, and in those of Chinese ancestry.[1,2,3] As in adults, TED is most often associated with acquired hyperthyroidism, but may occur in hypothyroid and euthyroid states as well.[4] One-third of children with Graves’ disease develop ophthalmopathy, with a median time of one month from diagnosis of Graves’ disease until development of TED, 82% of children had ocular complaints prior to being diagnosis in a study by Jarusaitiene et al.[2,5] Two-thirds of children with TED are between the ages of 11 and 18 years, presumably due to an increased prevalence of smoking in this age group.[2] postpubertal children seem to experience more serious complications, signs of TED are generally mild and self-resolving, potentially delaying diagnosis.[1,4] Common manifestations noted in the literature include upper eyelid retraction, proptosis, eyelid lag, pain, foreign body sensation, photosensitivity, tearing, and diplopia, while optic neuropathy and corneal breakdown are infrequent.[4] In addition, myopia may accompany proptosis.[4] In contrast to children, adults with Graves ‘ophthalmopathy seem to experience more severe disease manifestations, with higher rates of exophthalmos, restrictive myopathy, and optic nerve dysfunction.[3]

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