Endocrine Abstracts

Introduction: Graves’ disease is a rare and severe disease in children with a marked female predominance. The diagnosis is made in front of a very suggestive clinical picture most often grouping together a goiter, an exophthalmos and a picture of thyrotoxicosis, confirmed biologically by the presence of hyperthyroidism with positive anti-TSH receptor antibodies and radiologically by diffuse, homogeneous, hypervascular goiter. There are three essential therapeutic weapons: synthetic antithyroid drugs, radioactive iodine or surgery. We report the observation of an adolescent girl in whom Graves’ disease posed management difficulties.

Observation: We report the case of a 12-year-old patient, followed for Graves’ disease for 4 years on 40 mg per day of carbimazole with poor adherence to therapy. She currently has a thyrotoxicosis syndrome made up of palpitations and thermophobia. Cervical examination revealed a diffuse and homogeneous goiter. Biological hyperthyroidism is confirmed by suppressed TSH. The thyroid scintigraphy showed hyperfixing goiter. The patient underwent iratherapy treatment at a dose of 20 mci with a good clinical course and obtaining biological hypothyroidism after 6 months. LT4 treatment was started.

Discussion and conclusion: Graves’ disease is rare in children. It occurs in 0.02% of children. Its positive diagnosis is often easy, but its disease management remains a subject of controversy in pediatric endocrinology. Medical treatment with synthetic ant thyroid drugs is always attempted as a first-line treatment. Other treatment alternatives are surgery and iratherapy which allows rapid healing while avoiding complications from surgery.