Endocrine Abstracts

Introduction: Graves’ ophthalmopathy (GO) is an autoimmune disorder affecting the retro-orbital tissues. It represents the main extra- thyroidal expression of Graves’ disease (GD). In children, GO is less common and less severe than in adults. Herein we report a case of GO in a child.

Case report: An 11-year-old girl with family history of autoimmune thyroid disease was referred to our department for evaluation of suspected hyperthyroidism. She presented with heat intolerance, diaphoresis, palpitations, mood disturbances, tearing, photophobia, gritty eyes as well as a history of weight loss over the past few months. On physical examination, she had a body weight of 40 kg, a BMI of 16.65 kg/m². The pulse rate was 110 beats per minute (bpm). A diffuse goiter and a mild bilateral exophthalmos were also found. At the admission, laboratory tests revealed decreased TSH (<0.005 μIU/ml) and increased free T4 of 26.9 pmol/l. TSH receptors antibodies were positive. Doppler Ultrasonography revealed enlarged thyroid without focal lesions, with increased vascular flow in both lobes. The diagnosis of Graves’ disease was established. Treatment with Methimazole (15 mg) and propranolol (20 mg*3) was then initiated. Lubricating eye drops were prescribed for the ocular symptoms. Thyroid hormone levels normalized after 2 weeks and the girl was discharged from the hospital in good condition.

Conclusion: Although rare in childhood, GD remains the most prevalent cause of hyperthyroidism. Its ocular manifestations are much milder than in adult GO and their management requires, in the majority of cases, only a local treatment. A regular follow up is always needed.