Endocrine Abstracts

Graves’ disease is the most common cause of hyperthyroidism in children. The incidence in the UK and Ireland is unknown but estimated to be 0.84 per 100 000 people (0–15 yr olds). Due to an apparent high local incidence, a retrospective study was conducted on patients diagnosed with Graves’ disease in a district general hospital in the locality.

Aim: To evaluate the clinical features, investigations and treatment of patients diagnosed from 2004 onwards and to identify possible causes.

Method: A proforma was designed prior to data collection. Case notes and investigation reports were reviewed.

Results: Seven patients were identified (6 females, 1 male) with a mean age at diagnosis of 13.9 years (range 12–15 years). This gives a local incidence of 2.43 per 100 000 people (0–15 yr olds). The most frequent symptoms were heat intolerance (71%), anxiety (57%), irritability (57%), palpitations (57%) and weight loss (57%). The most frequent signs were goitre (86%) and tremor (57%). Thyroid peroxidise autoantibodies were found in all 7 cases and thyroid-stimulating hormone receptor antibodies were found in 86% of cases. All 7 patients received block and replacement therapy and 3 patients required propanolol for palpitations. Three patients achieved remission with a mean duration of treatment of 47.5 months. One patient had a total thyroidectomy.

Conclusion: Whilst considering the small sample size, the local incidence of Graves’ disease could be higher than the incidence for the UK and Ireland. Studies on monozygotic twins have demonstrated an environmental influence to the multifactorial aetiology with the susceptibility to the development of Graves’ disease due to non-genetic factors estimated to be 21%. Smoking is one factor that has been related to Graves’ disease and in our region there is a greater prevalence of smokers than the UK as a whole. Other potential factors include infection and high iodine intake.