Evaluation of clinical features and treatment results of graves disease in children and adolescent

Aim: In this study, we evaluated demographic, clinical, laboratory, treatment (medical, radioactive iodine and surgical) and remission results of patients diagnosed with Graves' disease in our clinic. Materials and Methods: The medical records of 44 patients with Graves' disease who presented to the Dokuz Eylül University Hospital Pediatric Endocrinology Clinic between years 1999-2018 were retrospectively investigated. The data that includes gender, complaints in the first presentation, age at the time of diagnosis, family history of thyroid disease, physical examination, laboratory findings, imaging studies, chosen treatment options and treatment responses were analyzed with descriptive statistical methods. Patients were classified into three risk groups (low, moderate and high) for relapse, according to laboratory findings and remission processes. Results: 44 patients were included in the study [35 (79.5%) were girls and the median age was 13.2 years (9.2 – 15 years)]. Half of the patients diagnosed in our clinic [Group I; 77.3% girls, median age 11 years (8.2 – 14.6 years)], the remaining 50% diagnosed in the outer center [Group II; 18 (81.8%) girls, median age 13.8 years (12.1 – 15.6 years)]. The most common complaints were palpitation (52.3%), sweating (52.3%), weight loss (38.6%), tremor (34%) and irritability (29.5%). In first physical examination; goiter was detected in 18 (40.9%), exophthalmos was in seven patients (15.9%), hypertension was in nine patients (20.5%) and tachycardia was in 19 (43.1%) of the patients. It was found that 23 patients (52.3%) were given propylthiouracil, 21 (47.7%) patients were given methimazole treatment; and in clinical follow-up five patients (11.4%) were in remission and nobody had relapse. Total thyroidectomy was performed in 10 patients (22.7%) and radioactive iodine treatment in four patients (9.1%) who did not undergo remission. Patients were divided into risk groups for relapse risk and 10 patients (35.7%) had low, 17 patients (60.7%) had moderate and one patient (3.6%) had high risk. Conclusion: In this study, patients diagnosed with the Graves disease in childhood, it is showed that low rate of remission related with the anti-thyroid treatment which is consistent with literature data, long term usage of anti-thyroid treatment on patiences who are convenient for medical treatment with the aim of increasing of remission rate due to low and temporary observed complications associated with medical treatment and also alternative treatment options could be preferred for the patients who are not in remission and have compatibility problem to medical treatment. Keywords: Anti-thyroid treatment, Graves' disease in children, Hyperthyroidism