Pediatric Thyroid Eye Disease: Clinical Characteristics and Orbital Decompression Outcomes

Chua, Michael; Tomlinson, Lauren A.; Binenbaum, Gil; Katowitz, William R.

doi:10.1097/iop.0000000000001137

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…The results of our study showed that proptosis was the most frequent clinical sign of paediatric GO followed by eyelid retraction and eyelid swelling, which is in line with the data published by Chua et al. (2018). Durairaj et al.…”

Section: Discussionsupporting

confidence: 93%

“…To our knowledge, this study represents the largest cohort of paediatric GO patients published to date. The gender distribution of our patients is similar to most of other studied cohort of paediatric GO patients, males being outnumbered (Goldstein et al 2008;Lim et al 2014;Chua et al 2018).…”

Section: Discussionsupporting

confidence: 85%

“…2014; Chua et al. 2018). Comparable to adult GO patients from the literature, the female to male ratio in our study was 4:1 (Dolman 2018).…”

Section: Discussionmentioning

confidence: 99%

“…Analysis of neuroimaging from earlier studies revealed EOM enlargement without significant apical crowding, however orbital fat tended to be more enlarged compared to EOM (Holt et al 2008;Chua et al 2018). Nonetheless, Wu et al reported three severe paediatric GO cases with compressive optic neuropathy which showed moderate to severe EOM enlargement and apical crowding on imaging (Wu et al 2017).…”

Section: Imagingmentioning

confidence: 97%

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Pediatric Graves’ orbitopathy: a multicentre study

Ionescu

Trotsenburg

Paridaens

et al. 2021

Acta Ophthalmologica

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Purpose: Graves' orbitopathy (GO) is a rare condition in children often considered to be a less severe condition than at an older age. The aim of our study was to analyse if there are any factors that distinguish paediatric from adult GO in order to provide guidelines for assessing and managing paediatric GO. Methods: Study design is a multicentre retrospective observational case series; 115 paediatric patients diagnosed with GO who visited our university medical centres in the Netherlands and Iran between 2003 and 2019 were submitted for complete ophthalmological examinations, serological testing and/or orbital imaging. Main outcome measures focussed on the natural course and clinical picture as well as medical and surgical treatment in paediatric GO. Results: Clinical findings included proptosis (n = 97; 84.3%), eyelid retraction (n = 77; 67%) and diplopia (n = 13; 11.3%). Ninety-two patients (80%) presented with mild disease, 21 (18.3%) with moderate-severe disease and two (1.7%) with severe GO. Five patients (4.3%) underwent intravenous glucocorticoids and 25 patients underwent orbital decompression surgery. Strabismus surgery due to primary involvement of extraocular muscles was performed in two patients (1.7%). Overall, rehabilitative surgical treatment was planned in 31 patients (26.9%) with inactive disease. Two patients experienced reactivation of the disease. Conclusion: Despite the fact that paediatric and adult GO are considered two separate entities, they might be the same disease with two different clinical phenotypes. Paediatric GO population presents with a comparable clinical picture regarding both soft tissue involvement and proptosis, which may require surgical intervention. Proptosis was present in the majority of paediatric GO patients. Orbital decompression was performed in 21.7% of patients.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 85%

“…2014; Chua et al. 2018). Comparable to adult GO patients from the literature, the female to male ratio in our study was 4:1 (Dolman 2018).…”

Section: Discussionmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 97%

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Pediatric Graves’ orbitopathy: a multicentre study

Ionescu

Trotsenburg

Paridaens

et al. 2021

Acta Ophthalmologica

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“…Decompression surgery is best deferred until the facial skull has fully grown. Success rates are the same as in adults ( 85 , 86 ).…”

Section: Pediatric Graves’ Orbitopathymentioning

confidence: 99%

2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

Mooij

Cheetham

Verburg

et al. 2022

European Thyroid Journal

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Hyperthyroidism caused by Graves’ disease (GD) is a relatively rare disease in children. Treatment options are the same as in adults – antithyroid drugs (ATD), radioactive iodine (RAI) or thyroid surgery, but the risks and benefits of each modality are different. The European Thyroid Association guideline provides new recommendations for the management of pediatric GD with and without orbitopathy. Clinicians should be alert that GD may present with behavioral changes or declining academic performance in children. Measurement of serum TSH receptor antibodies is recommended for all pediatric patients with hyperthyroidism. Management recommendations include the first-line use of a prolonged course of methimazole/carbimazole ATD treatment (3 years or more), a preference for dose titration instead of block and replace ATD, and to avoid propylthiouracil use. Where definitive treatment is required either total thyroidectomy or RAI is recommended, aiming for complete thyroid ablation with a personalized RAI activity. We recommend avoiding RAI in children under 10 years of age but favor surgery in patients with large goiter. Pediatric endocrinologists should be involved in all cases.

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Hyperthyroidism in childhood and adolescence

Rivkees

2024

Reference Module in Biomedical Sciences

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Pediatric Thyroid Eye Disease: Clinical Characteristics and Orbital Decompression Outcomes

Abstract: Pediatric TED patients exhibit mild symptoms, such as proptosis and eyelid retraction without strabismus, vision loss, or optic neuropathy. Some children with TED have severe disfigurement and corneal exposure due to the disease and benefit from orbital decompression.

Cited by 12 publications

References 14 publications

Pediatric Graves’ orbitopathy: a multicentre study

Pediatric Graves’ orbitopathy: a multicentre study

2022 European Thyroid Association Guideline for the management of pediatric Graves’ disease

Hyperthyroidism in childhood and adolescence

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