Demographic, anthropometric and clinical characteristics of patientsdiagnosed with graves and examining the relationship between Celiac Disease and other autoimmune diseases

Background: Graves‟ Disease, which is the most common (95%) cause of hyperthyroidism in childhood and adolescence, is an endocrine problem that has significant effects on growth and development. Its prevalence in childhood is 1/10.000 and it occurs as a result of stimulation of the thyroid gland by antibodies developed against its receptors. It is an autoimmune disease, polygenic, and environmental and genetic factors play an important role in the development of the disease. Aim: In this study, it was aimed to retrospectively examine the demographic, anthropometric and clinical characteristics of patients diagnosed with Graves' disease and to examine the relationship between Celiac disease and other autoimmune diseases. Materials and Methods: The files of 40 pediatric patients who were followed up with the diagnosis of Graves' disease between 01.01.2015-01.01.2023 in Akdeniz University Faculty of Medicine, Department of Pediatrics, Division of Pediatric Endocrinology were retrospectively analyzed. Demographic and anthropometric characteristics, presenting complaints, physical examination and laboratory findings, treatment-related characteristics, remission and relapse status of the patients were evaluated. Patients were divided into risk groups (low, intermediate and high risk) according to clinical, laboratory and treatment characteristics. They were also classified according to the duration of treatment (<1 year, 1-2 years and >2 years) and the level of hyperthyroidism (severe and non-severe). Results: 40 patients were included in the study. Of these patients, 32 (80%) were girls and eight (20%) were boys and their median age was 14 years (3.2-17.7 years). 32 of the patients (80%) were in the pubertal period. A family history of thyroid disease was seen in 55% and consanguinity between parents was seen in 7.5%. It was determined that two (5%) patients had an accompanying autoimmune disease, one (2.5%) patient with psoriasis and one (2.5%) patient with Celiac disease. The most common presenting complaints were palpitations in 16 (40%), hair loss in 12 (30%), weight loss in 11 (27.5%), fatigue in 8 (20%), chills in 7 (17.5%), sweating in 6 (15%) and nervousness in 6 (15%) patients. Physical examination findings at presentation included goiter in 19 (47.5%) patients, tachycardia in 15 (37.5%), murmur in three (7.5%), ophthalmopathy in three (7.5%), tremor in one (2.5%) and hypertension in one (2.5%). All patients were started on methimazole as initial treatment and one patient was switched to propylthiouracil in the first month of treatment. When the patients were grouped according to the duration of treatment by excluding those who dropped out of follow-up, four (14.3%) patients received treatment for <1 year, seven (25%) for 1-2 years, and 17 (60.7%) for >2 years. When risk groups were analyzed, 10 (25%) patients were in the low risk group, 19 (47.5%) patients were in the medium risk group, and 11 (27.5%) patients were in the high risk group. In addition, five (12.5%) patients were considered to have severe hyperthyroidism and 35 (87.5%) patients were considered to have non-severe hyperthyroidism. Conclusion: In our study, it was found that the frequency of side effects was associated with gender, age at diagnosis and duration of treatment, sT4 and sT3 values at presentation were significantly different between risk groups. In addition, patients in the severe hyperthyroidism group had significantly higher thyroid volume on ultrasonography. Keywords: Graves' disease in children, Celiac disease, hyperthyroidism, anti- thyroid treatment