Special Features of Graves' Disease in Early Childhood

Abstract

Graves' disease (GD) is extremely rare in children younger than 4 years of age, but if not recognized and treated it can seriously interfere with growth and development. We report three unrelated children, all females, in whom GD occurred before the age of 3. These children presented with goiter, exophthalmos, tachycardia, and hyperactivity. Moreover, one showed a severe psychomotor delay, and had previously undergone surgery due to craniosynostosis; the other two manifested a language delay. All had high thyroid hormones and thyrotropin receptor antibody (TRAb) serum levels that clearly indicated autoimmune hyperthyroidism. In all of them, the disease presumably had developed during the first or second year of life. No maternal history of GD was present in two. The third child was born to a mother affected with GD during pregnancy, but it is likely that her GD began to develop after 6 months of life. These children are being treated with methimazole, and treatment is still necessary after 32 months. TRAb levels were persistently high at follow-up. Psychological evaluation including language development at follow-up was appropriate for age in two children; the third child improved, but severe mental retardation is still evident. GD assessment in early childhood also needs to focus on psychological evaluation. Pediatricians should be aware of the possibility of permanent brain damage and craniosynostosis due to hyperthyroidism in infancy.

Advanced Bone Formation in Mice with a Dominant-negative Mutation in the Thyroid Hormone Receptor β Gene due to Activation of Wnt/β-Catenin Protein Signaling

“…By contrast, thyrotoxicosis in children accelerates growth and skeletal maturation but also causes short stature due to early fusion of the growth plates. Premature fusion of the sutures of the skull is also seen in severely affected young children and may lead to craniosynostosis (5). These observations demonstrate sensitivity of the skeleton to disturbances of thyroid status during postnatal growth and indicate the importance of thyroid hormones during bone development.…”

Fetal neonatal hyperthyroidism: diagnostic and therapeutic approachment

“…Palpebral retraction is related with thyrotoxicosis and exophthalmos is related with autoimmune pathology. The clinical picture resolves in 3-16 weeks with elimination of maternal antibodies (15). It has been reported that biochemical hypothyrodism is observed in both twins initially, whereas hyperthyroidism may be observed in one and biochemical hypothyroidism may be observed in the other subsequently (28).…”

“…The growth problem is related with both hyperthyroidism and preeclampsia. Other fetal findings include tachycardia (heart beat >160/min), heart failure, hydropsis, acceleration in bone age, craniosynocstosis, and microcephaly (15).…”

“…Late neonatal hyperthyroidism may occur in the late period in relation with the antibodies remaining in the serum because the half-life of the blocking antibodies is about 12 days (24). Although this picture is observed in three weeks at the earliest, it generally occurs in 6-8 weeks in the postnatal period (15,19).…”

Excesso de tiroxina materna associado ao hipertireoidismo pós-natal reduz o crescimento ósseo e o perfil proliferativo e angiogênico das cartilagens de crescimento de ratos

“…A tireotoxicose juvenil pode estar associada ao crescimento acelerado e à idade óssea avançada. No entanto, há relatos de redução da estatura devido à fusão prematura das placas de crescimento (Segni et al, 1999;Bassett et al, 2007).…”