Pediatric Graves’ orbitopathy: a multicentre study

Abstract

Purpose: Graves' orbitopathy (GO) is a rare condition in children often considered to be a less severe condition than at an older age. The aim of our study was to analyse if there are any factors that distinguish paediatric from adult GO in order to provide guidelines for assessing and managing paediatric GO. Methods: Study design is a multicentre retrospective observational case series; 115 paediatric patients diagnosed with GO who visited our university medical centres in the Netherlands and Iran between 2003 and 2019 were submitted for complete ophthalmological examinations, serological testing and/or orbital imaging. Main outcome measures focussed on the natural course and clinical picture as well as medical and surgical treatment in paediatric GO. Results: Clinical findings included proptosis (n = 97; 84.3%), eyelid retraction (n = 77; 67%) and diplopia (n = 13; 11.3%). Ninety-two patients (80%) presented with mild disease, 21 (18.3%) with moderate-severe disease and two (1.7%) with severe GO. Five patients (4.3%) underwent intravenous glucocorticoids and 25 patients underwent orbital decompression surgery. Strabismus surgery due to primary involvement of extraocular muscles was performed in two patients (1.7%). Overall, rehabilitative surgical treatment was planned in 31 patients (26.9%) with inactive disease. Two patients experienced reactivation of the disease. Conclusion: Despite the fact that paediatric and adult GO are considered two separate entities, they might be the same disease with two different clinical phenotypes. Paediatric GO population presents with a comparable clinical picture regarding both soft tissue involvement and proptosis, which may require surgical intervention. Proptosis was present in the majority of paediatric GO patients. Orbital decompression was performed in 21.7% of patients.

Longitudinal follow-up of pediatric Graves’ disease in preschool children: Clinical characteristics and a case report

“…Eighty percent of patients had mild disease, 18.3 percent had moderate-severe disease and 1.7 percent had severe Graves' ophthalmopathy (GO). [21] In Chinese children with GO, lower eyelid retraction was the most common clinical sign (38.6%). [22] Young-age-of-onset GD differs from juvenile hyperthyroidism.…”

The management of pediatric Graves’ disease

“…More severe features such as optic nerve dysfunction and muscular restriction are very rare [21]. A recent multicenter study (the largest published to date on this subject) found that out of 115 pediatric patients with GO, 2 (1.7%) had severe disease [22]. However, a significantly larger percentage (21.7%) ultimately underwent orbital decompression once the disease had stabilized, for the main indication of persistent proptosis and its significant impact on QOL [22].…”

Graves’ Disease in Children: A Comprehensive Review on Diagnosis, Treatment, and Long-Term Considerations

“…As the condition progresses, TSH-receptor antibodies stimulate these receptors in orbital fibroblasts, which produce cytokines and glycosaminoglycans, to trigger lymphocyte and myofibroblast proliferation. 32 Then, as edema progresses, a patient may present with proptosis, movement restriction, and peribulbar swelling. However, pediatric patients tend to have more softtissue involvement than EOM implications.…”