Abstract
Purpose To investigate juvenile Graves' ophthalmopathy (GO) signs and compare Graves' disease (GD) course in patients with or without GO. Patients and Methods There were analyzed data (visual acuity, proptosis, palpebral fissure measurements, clinical activity score (CAS), and the course of GD) of 67 children who have been newly diagnosed with GD. 26.9% of patients with GD had signs of ophthalmopathy (GO+), and 73.1% were without ophthalmopathy (GO−). Results Upper eyelid retraction (72.3%), proptosis (66.7%), and soft tissue changes (27.8−38.9%) were in GO+ patients. The palpebral fissure, CAS, and proptosis values were greater in the GO+ group than in the GO− group (p < 0.001). GD course in GO+ patients was longer than that in GO− patients (p < 0.001). The duration of the first remission was longer in GO− than in GO+ patients (p < 0.001). The duration of first remission was longer than one year for 61.2% in GO− and 33.3% in GO+ patients (p < 0.02). Conclusion The common manifestations of juvenile GO patients were upper eyelid retraction, proptosis, and soft tissue involvement. The study demonstrates that pediatric patients with GO are more likely to have a severe course of autoimmune thyroid disease.
Highlights
Juvenile Graves’ disease (GD) is a rare disease; its clinical signs are less well defined in comparison with adults [1,2,3,4]
Authors show that patients with GD who relapsed or remained in remission did not differ with respect to age, goiter size, Graves’ ophthalmopathy (GO), and serum T4 or T3 [21]
The diagnosis of GD was made by an endocrinologist and based on commonly accepted clinical and laboratory criteria: clinical symptoms of hyperthyroidism, increased serum concentrations of free thyroxin (FT4), free triiodothyronine (FT3), suppressed thyrotropin (TSH) concentrations, increased serum concentrations of TSH receptor antibodies (TSHR Ab), and diffuse goiter on palpation and ultrasound
Summary
Juvenile GD is a rare disease; its clinical signs are less well defined in comparison with adults [1,2,3,4]. According to low incidence of GO between children, manifestation of this disease is poorly analyzed and mainly investigated in adults. This raises the risk of the identification of GO signs too late. There have been few studies of the relationship between the duration of therapy with antithyroid drugs and the relapse risk in pediatric patients. Few studies showed the impact of GO on remission or relapse rates of adult Graves’ hyperthyroidism [18,19,20]. The treatment and long-term remission or relapse rates following antithyroid drug therapy in juvenile patients with GD, and ophthalmopathy results are controversial and remain debatable. Authors show that patients with GD who relapsed or remained in remission did not differ with respect to age, goiter size, GO, and serum T4 or T3 [21]
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