Behavioral assessment of children and adolescents with Graves’ disease: A prospective study

Abstract

Previous studies have identified frequent comorbid neuropsychiatric disorders and conditions in adults with thyrotoxicosis. These studies are scarce or even lacking in pediatric population. This work aimed to study the behavior of children and adolescents with Graves’ disease (GD). This study included 35 children with GD (boys = 15; girls = 25; mean age: 11.45±1.50yrs) and 40 healthy children (boys = 20; girls = 20; mean age: 12.54±1.62yrs). Behavior was assessed using Child Behavior Checklist (CBCL). Children with GD were assessed during periods of thyroid hormone elevation (active disease) and normalized thyroid hormones (with anti-thyroid drugs or ATDs). Compared to healthy children, patients during periods of thyroid hormone elevation (74.29%) and normalized thyroid hormones (31.43%) had higher frequencies of behavioral abnormalities and scorings of total CBCL scale (P = 0.01; P = 0.04, respectively) and its subscales’ [Anxious/Depressed (P = 0.02; P = 0.04), Withdrawn/Depressed (P = 0.03; P = 0.04) and Somatic Complaints (P = 0.03; P = 0.127) and Social (P = 0.01; P = 0.225), Thought (P = 0.01; P = 0.128) and Attention (P = 0.01; P = 0.01) problems], indicating internalizing and externalizing problems. The majority of patients had at least two different behavioral problems. Marked improvement was found during period of normalized thyroid hormones (P = 0.001). Correlation analyses showed significant associations between total CBCL scoring and age at onset (P = 0.01; P = 0.001) and lower concentrations of thyroid stimulating hormone (TSH) (P = 0.001; P = 0.04) and higher concentrations of free thyroxine (fT4) (P = 0.01; P = 0.02), triiodothyronine (fT3) (P = 0.01; P = 0.03) and thyrotropin receptor antibodies (TRAbs) (P = 0.001; P = 0.01) during periods of thyroid hormone elevation and normalized thyroid hormones, respectively. Multiple linear regression analysis showed that "at presentation" lower concentrations of TSH (P = 0.001; P = 0.03) and higher concentrations of fT4 (P = 0.001, P = 0.01), fT3 (P = 0.01; P = 0.06) and TRAbs (P = 0.001; P = 0.001) were predictors of behavioral problems during periods of active disease and normalized thyroid hormones. We conclude that GD is associated with higher frequencies and severities of anxiety, depression and inattention during periods of thyroid hormone elevation as well as normalized thyroid hormones with ATDs. Therefore, early diagnosis and optimizing management are required to improve children’s social life.

Tocilizumab use in pediatric thyroid eye disease: First documented case

“…The most common associations were Anxiety/Depression and inattention. 22 Due to that matter, more research into a novel treatment with a lower side effect profile could potentially increase the quality of life of patients in a short time without having to anticipate the side effects, thus we conducted this case report to further encourage research into Tocilizumab being a potential agent that might carry less side effects as evidenced by a study mentioned earlier.…”

“…It is rare to experience optic nerve compression or exposure keratopathy in children than adults. 4 , 5 , 6 Nevertheless, the effect on quality of life through the psychological burden of the disease on children is probably worse than adults. 7 …”

“… 4 , 5 , 6 Nevertheless, the effect on quality of life through the psychological burden of the disease on children is probably worse than adults. 7 …”

Definitive treatment of Graves’ disease in children and adolescents

“…As in adults, pretreatment with ATDs is useful, with the medication being stopped 3-5 days before RAI. and hypothyroidism (because of treatment) may result in educational and social difficulties in young patients, and this factor must be taken into account throughout the whole process of therapeutic decision making [11].…”

Tocilizumab as a Useful Tool for Thyroid Eye Disease in Pediatric Population: A Case Report

“…Although clinically relevant TED is in general milder than in adults [ 3 , 6 ], rarely, some children present progressive and severe disease, culminating in severe disfigurement and corneal exposure that may require orbital decompression [ 7 ]. Moreover, the psychological burden caused by the disease is probably higher in children than in adults, even in mild disease [ 8 ]. Therefore, it is essential to guarantee timely diagnosis and management to avoid unwanted complications [ 5 ].…”