Graves’ disease in children results from an autoimmune attack on the thyroid gland. Treatment options include medication, radioactive iodine, and surgery.
Graves’ disease is an autoimmune condition that causes the thyroid gland to become overactive. The thyroid is a gland in the neck that produces hormones involved in the body’s energy use.
Although Graves’ disease usually occurs in adults, it can also affect children. Graves’ disease is the most common reason for hyperthyroidism, or overactive thyroid, in children.
The exact cause of Graves’ disease is unknown, but a combination of factors may be involved in its development. These factors include:
- immunological
- environmental
- genetic
When a person has Graves’ disease, their immune system produces thyroid receptor antibodies (TRAb), which bind to cell receptors for thyroid stimulating hormone (TSH).
This results in:
- uncontrolled thyroid activation
- thyroid enlargement
- excess production of thyroid hormone
- excessive reproduction of follicular (hormone-secreting) cells
An estimated 40% of children with Graves’ disease have a family history of thyroid disease.
Other risk factors that increase a child’s chances of developing Graves’ disease
- stress
- exposure to tobacco smoke
- infection
- iodine exposure
- highly active antiretroviral therapy (HAART)
- the medication interferon alfa
- female sex
- adolescent age
Symptoms of Graves’ disease in children include:
- goiter (enlargement or lumpiness of the thyroid)
- neck swelling
- rapid heart rate
- diarrhea
- increased appetite without weight gain
- weight loss
- increased stool frequency
- moodiness
- headache
- decreased exercise tolerance
- heat intolerance
- sleep disruption
- impaired concentration
- reduced academic performance
- symptoms of attention deficit hyperactivity disorder (ADHD)
- tall stature
- accelerated bone maturation
- skin changes
- excessive perspiration
- facial flushing
- itching
- high blood pressure
- tremors
- hyperactive deep tendon reflexes
- muscle weakness
- infrequent blinking
- painful, gritty, or dry eyes
- vomiting
- fainting
Because Graves’ disease symptoms can mimic conditions like ADHD, a thorough assessment is important to arrive at the correct diagnosis.
Healthcare professionals diagnose Graves’ disease by assessing a child’s symptoms, reviewing their medical history, and ordering blood tests.
Blood tests reveal the levels of hormones such as TSH, as well as the presence of antibodies like TRAb.
Graves’ disease in children has several treatment options. The first line treatment is generally anti-thyroid drugs (ATD).
Anti-thyroid drugs
Graves’ disease features a cycle of hyperthyroidism, increasing the production of TRAb, which in turn creates more hyperthyroidism. The goal of ATD is to break this cycle by restricting the synthesis of thyroid hormone.
Optimal thyroid function usually occurs after 2 to 6 weeks of medication use. Once a child’s thyroid hormone level is in the target range, their doctor can recommend a minimum effective maintenance dose.
Some children experience Graves’ disease remission as a result of medication therapy. A
The study found that 17.8% of participants experienced remission, and 57.4% experienced relapse after they discontinued using anti-thyroid drugs. Children in the remission group had used ATDs longer prior to stopping than those in the relapse group.
A 2020 study found a higher chance of remission after ATD use in children who:
- were 5 years of age or younger
- had no family history of thyroid disease
- had lower initial TRAb levels
ATD is the usual first choice of treatment for Graves’ disease in children, but when it is not effective, doctors may consider definitive measures like radioactive iodine (RAI) or thyroidectomy surgery.
Radioactive iodine
RAI damages the thyroid gland so that it is not as active.
RAI can achieve either euthyroidism or hypothyroidism (low thyroid function).
A person receiving RAI treatment takes it in the form of a capsule or liquid. The treatment targets the thyroid because of the gland’s absorption of iodine from the bloodstream. Once the iodine is in the thyroid, the radiation destroys some of its cells.
It might seem like aiming for normal thyroid function is preferable to low. However,
When RAI treatment results in hypothyroidism, the person will need to take thyroid medication long-term to replace the hormones that the thyroid no longer produces.
Thyroidectomy
Thyroidectomy is surgery to remove part or all of the thyroid gland. Anyone having this treatment will need long-term treatment with thyroid replacement medication.
Since thyroid hormones affect most of the body, untreated Graves disease has numerous potential complications, some of which include:
- thyroid-associated ophthalmopathy (TAO)
- liver dysfunction
- abnormal peripheral blood cells
- reduced bone mineralization
- bone fractures
- muscle disorders
- irregular or absent menstruation
- absence of ovulation
- cardiomyopathy
- heart failure
Thyroid storm is another potential complication of Graves’ disease. It is a medical emergency with a fatality rate of
Thyroid storm can happen as a result of undiagnosed Graves’ disease or from surgery or infection exposure. Not sticking with treatment medication can also lead to thyroid storm.
Symptoms include:
- unusually high body temperature
- rapid heart rate
- rapid heart arrhythmia
- heart failure
- gastrointestinal disturbance
- anxiety
- liver enlargement
- respiratory distress
- seizures
- delirium
There are ways parents and caregivers can support their child who lives with Graves’ disease.
If a child takes ATD for Graves’ disease, parents or caregivers can help by making sure the child takes the medication according to the doctor’s instructions. They can also monitor their child for medication side effects or the return of Graves’ disease symptoms.
Finding a support group may help a child feel less isolated. Meeting others in the same situation can help them learn more about their condition and offer moral support.
Since Graves’ disease can affect attention and concentration, a child may benefit from support at school. Parents and caregivers can speak with their child’s school staff to find out about academic accommodations.
A medical assessment is appropriate for a child not previously diagnosed with Graves’ disease who starts to show symptoms. The correct diagnosis can lead to helpful treatment and a reduced chance of condition complications.
If a child has already received a Graves’ disease diagnosis, they should see a healthcare professional if their symptoms return or if they experience treatment side effects.
Graves’ disease is an autoimmune condition that causes hyperthyroidism. It usually happens in adults, but children can also develop Graves’ disease.
Symptoms include signs associated with an overactive thyroid, such as rapid heart rate, moodiness, and weight loss. The correct diagnosis helps prevent complications that can happen when Graves’ disease is left untreated.
Treatment options for Graves’ disease in children include medication, radioactive iodine, and surgery.