How To Diagnose And Treat Graves Disease In Children?

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Graves’ disease in children is a chronic autoimmune condition, which means the child’s immune system causes the condition. Graves’ disease accounts for 10–15% of all endocrine and thyroid disorders in children and teens. According to the Children’s Hospital Of Philadelphia (CHOP), the condition affects about one in 10,000 children in the US. It is characterized by weight loss, increased heartbeat, fatigue, and other health issues that require long-term medical intervention (1) (2). It is also among the most common causes of hyperthyroidism in children.

Read this post to learn more about the causes, symptoms, diagnosis, and treatment modalities for Graves’ disease in children.

In This Article

What Causes Graves’ Disease In Children?

The exact cause of Graves’ disease remains unclear, but it is believed that the disease is caused due to genetic and environmental factors. The pathophysiology of the disease is based on the binding of an antibody called thyroid-stimulating immunoglobulin (TSI) to the thyroid-stimulating hormone (TSH), signaling an increased synthesis of thyroid hormones, T3 and T4, and growth in the thyroid gland (overactive thyroid). It eventually leads to hyperthyroidism (3).

Studies suggest that alterations in several genes (the majority of them belonging to the HLA complex) increase a person’s overall risk of developing this disease (4). In addition, genes involved in thyroid function (thyroglobulin (Tg) or the thyroid-stimulating hormone receptor (TSHR) genes) and modification of immune responses (such as CD25, CD40, CTLA-4, and FOXP3 genes) are also linked to the development of Graves’ disease (5).

What Are The Risk Factors For Graves’ Disease?

Chronic stress could be a risk factor for Graves disease

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Children are more at risk of developing Graves’ disease if they (6) (7):

Have a family history of thyroid disorders
Have a family history of autoimmune conditions
Are female and are nearing puberty (puberty marks hormonal changes)
Consume abnormal amounts of iodine through diet or medications
Are subjected to chronic stress
Have a history of viral or bacterial infections

Have chromosomal abnormalities such as Down's syndromeⁱXA genetic condition where a person has an extra chromosome apparent through facial features, and speech and language problems. or Turner syndromeⁱXA genetic condition where one of the two x chromosomes in females is missing or underdeveloped.
Have the habit of smoking

What Are The Symptoms Of Graves’ Disease In Children?

Trouble sleeping could happen due to Graves disease

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The symptoms of Graves’ disease may vary among children. However, the most common signs of this condition are (6) (7):

Swelling around the neck
Difficulty in swallowing
Rapid heartbeats
Increased blood pressure
Trouble sleeping
Weight loss, despite a good appetite due to an increased basal metabolism
Excess sweating due to heat intolerance

Shaking of hands and legs, nervousness
Protruding eyes
Chronic fatigue and weakness
Hyperactivity and irritability
Frequent mood swings
Poor concentration
Hair loss, especially around the scalp
Sensitivity to heat or cold
Frequent urination and bedwetting
Changes in menstrual cycle in girls
Frequent feelings of being emotionally low, anxiety, depression, crying or yelling
Slow growth rate, leading to short height and growth retardation

Quick Fact

The onset of symptoms is usually gradual, often taking several weeks or months to develop (5).

The symptoms of Graves’ disease may resemble other health conditions seen in children. Get a pediatric consultation if you notice any signs in your child for appropriate diagnosis and definite treatment.

How Is Graves’ Disease Diagnosed In A Child?

A series of blood tests are done to measure the levels of T3, T4, and thyroid-stimulating hormones

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Experts suggest that a combination of physical examination, a detailed study of a patient’s history, and specific lab tests are essential for diagnosing Graves’ disease in children. Your child’s doctor may suggest the following tests (8).

Physical examination: It helps detect signs of restlessness, tremors, palpitations, abnormal heart rates, bulging eyes, and blood pressure abnormalities.

Blood tests: A series of blood tests are done to measure the levels of T3, T4, and thyroid-stimulating hormones. Additional blood tests may also be done to check the TSI antibody levels.

Ultrasound: An ultrasound is used to detect an enlarged thyroid gland and increased blood circulation in the thyroid gland.

Radioactive Iodine uptake scan: This is an additional test used when the lab tests and scan cannot confirm the diagnosis. The test helps in determining iodine absorption by the thyroid gland.

How Is Graves’ Disease In Children Treated?

Radioactive iodine therapy is effective if your child has serious side effects from medicines.

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The treatment for Graves’ disease in children will depend on the age, the severity of symptoms, medical history, and overall health status of the child. Your child’s doctor may consider the following treatment options (1).

Antithyroid medications: Antithyroid drugs are used as initial treatment for Graves’ disease in children. Remission is achieved in most children after treatment with antithyroid drug therapy. These drugs are known to suppress the synthesis of thyroid hormones. The most commonly used drugs are carbimazole, propylthiouracil, and methimazole.

Radioactive iodine: Radioactive iodine therapyⁱXA treatment where radioactive capsules are ingested orally to destroy or shrink thyroid cells. is effective if your child has serious side effects from medicines. The low-dose iodine therapy aims at preventing the recurrence of Graves’ disease.

Thyroidectomy: This is a surgery indicated in children who don’t respond to medications or radioactive iodine therapy. Surgery is an option only in serious cases as there is a possibility of acute to serious complications, such as hemorrhage, after the surgery.

Things to know

Propylthiouracil is a thyroid medicine that is usually avoided due to its potential side effects, including liver failure (6).

Discuss with your child’s doctor the suitable therapy for your child and the guidelines to follow while monitoring your child after treatment.

What Are The Complications Of Graves’ Disease?

Graves ophthalmopathy is a rare vision-threatening condition.

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A common complication of Graves’ disease in children is Graves ophthalmopathy, a rare vision-threatening condition. In some cases, overexposure to certain treatment drugs may cause agranulocytosis, a rare bone marrow disorder leading to insufficient production of white blood cells. Untreated hyperthyroidism may lead to a rare but serious condition called thyroid storm, causing high fever and blood pressure (3) (7).

Point to consider

Elevated thyroid hormone levels affect the body’s ability to get calcium into the bones, which may make the bones brittle (7).

Frequently Asked Questions

1. Can Graves’ disease be cured in children?

Graves’ disease can’t be cured entirely. However, it can be managed with prompt medical treatment modalities, such as antithyroid medications and radioactive iodine therapy. The kind of treatment that will work for a child depends on several factors, such as age and the severity of their symptoms.

2. Does Graves’ disease shorten life expectancy?

Graves’ disease in itself isn’t life-threatening. However, lack of prompt treatment can cause several health complications that may affect life expectancy.

3. Are there any dietary considerations for children with Graves Disease?

There are no specific dietary considerations, although avoiding refined foods with added sugars and caffeine is recommended. It is also advised to add more calcium, protein, and antioxidants to the child’s diet (9).

4. How can Graves Disease in children be prevented?

Since the exact cause of Graves disease is not known, there are no known strategies to prevent this condition (10).

5. How often should children be screened for Graves Disease, and at what age?

Generally, after the diagnosis, the treatment is started, and the thyroid hormone levels are checked monthly. After normalizing thyroid levels, the blood tests would be done once every two to three months. Furthermore, once the condition is under control, the child would be screened every six to 12 months (8).

Graves’ disease in children may be caused by genetic or environmental factors, and you may recognize the condition by swelling around the neck, increased heartbeat, and sleeping troubles. Doctors may be able to diagnose Graves’ disease with physical examinations, blood tests, and other diagnostic tests. Once the disease is confirmed, doctors may treat the child with antithyroid medications, radioactive iodine, or surgery. Although the treatment is effective, some children may complain of drug-based side effects. So, talk to your child’s pediatrician about your concerns and formulate a plan that helps manage the condition effectively.

Infographic: What Are The Risk Factors For Graves’ Disease?

Certain factors may increase a child’s risk of developing Graves’ disease, an autoimmune condition affecting the thyroid gland. Here is an infographic listing some such aspects. Identifying these risk factors and seeking medical attention if any symptoms arise in your child are essential to ensure timely and effective treatment.

factors that increase the likelihood of graves disease (infographic)

Get the high-quality PDF version of this infographic.

Key Pointers

Graves’ disease in children may show a range of symptoms such as swelling around the neck, excess sweating, poor concentration, and protruding eyes.
The notable risk factors for the condition include a family history of thyroid disorders, autoimmune conditions, and bacterial or viral infections.
Physical examinations, blood tests, ultrasound, and radioactive iodine uptake scans help diagnose the disease.
Antithyroid medications, radioactive iodine, and thyroidectomy may help treat the disease.

Image: Stable Diffusion/MomJunction Design Team

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Learn about the medical management of Graves’ Disease in children and adolescents. Understand the treatments available and how to best manage the condition.

References

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