Thyroidectomy in a two-year old for graves’ disease

ObjectivesGraves’ disease (GD) is rare in children under age five years. Antithyroid drugs are typically first-line therapy but carry the risks of agranulocytosis and liver dysfunction.Case presentationA male infant with multiple congenital anomalies, left ventricular hypertrophy, and neurologic dysfunction developed GD at five months of life. The presence of chronic hepatitis complicated medical management. Potassium iodide was effective temporarily, but urgent thyroidectomy was required at nine months of age. Postoperatively, the patient developed a thyroid function pattern consistent with impaired pituitary sensitivity to thyroid hormone (TH) that responded to the addition of liothyronine. Exome sequencing revealed a heterozygous de novo duplication of the ATAD3 gene cluster, suggesting a possible mitochondrial disorder.ConclusionsThis case describes the youngest child to date to be diagnosed with endogenous GD and to successfully undergo definitive treatment with thyroidectomy. An underlying defect in mitochondrial function is suspected, suggesting a potential novel pathophysiologic link to early-onset thyroid autoimmunity. Additionally, this case illustrated the development of impaired pituitary sensitivity to TH following thyrotoxicosis of postnatal onset, which may contribute to our understanding of hypothalamic-pituitary-thyroid (HPT) axis development.

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Thyroidectomy in a two-year old for graves’ disease

Abstract: HighlightsThe most common cause of hyperthyroidism in children is graves’ disease.Surgery is utilized as a therapy for graves’ disease but rarely employed in children.This case report represents the youngest patient to undergo thyroidectomy for graves’ disease.

Cited by 2 publications

References 11 publications

Pediatric Graves’ Disease: Surgical Interventions in a Single Institution – A Comprehensive Case Series

Pediatric Graves’ Disease: Surgical Interventions in a Single Institution – A Comprehensive Case Series

Graves’ disease in a five-month-old boy with an unusual treatment course

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