Graves' Disease (Children)

Graves' Disease is an autoimmune disorder which causes elevated thyroid levels in the body. It accounts for approximately 10% to 15% of childhood thyroid diseases¹ and is more common between the age group of 10 and 15 years². There is often a delay in the diagnosis of Graves' Disease as the symptoms are non-specific like fatigue, mood variations and increased appetite.

The thyroid gland is a butterfly-shaped gland present in the neck. It is made of two lobes on either side of the neck and connected in the middle by a narrow piece of tissue called isthmus. In Graves' Disease, the thyroid gland is overactive which causes an increase in the thyroid hormone levels. This suppresses the brain's production of Thyroid-Stimulating Hormone (TSH).

Graves' Disease is caused by a combination of genetic, environmental and autoimmune factors. In this condition, auto-antibodies are produced against the thyroid gland. The most common antibody seen in Graves' Disease is Thyroid Receptor Antibody (TRAb).

Source:¹PubMed, ²Bluestone and Stool's Pediatric Otolaryngology, Volume 1

In Graves' Disease, the most common symptoms include swelling in the front of the neck (also called a goitre), weight loss despite having a good appetite, palpitations, increased perspiration, diarrhoea, hyperactivity, emotional lability and worsening school performance. Other signs include finger tremors, tachycardia (fast resting heart rate) and increased blood pressure.

If your child has any of the above symptoms, a simple blood test is necessary to check his or her blood for free thyroxine (T4), TSH and TRAb levels. An elevated free T4 level associated with a suppressed TSH level and positive TRAb level will confirm the diagnosis of Graves' Disease.

The first-line treatment is consuming carbimazole tablets which reduces the free T4 levels. If there are symptoms of palpitations and tachycardia, propranolol is given to alleviate these symptoms. When Graves' Disease is not well-controlled by carbimazole, the second-line treatment is radioactive iodine or surgery to remove the thyroid gland.

During treatment, there is a need for close follow-ups with a series of blood tests. All children will require treatment for a minimum of two years during which some may achieve remission. Remission means having normal thyroid function even after discontinuing carbimazole but there will still be a risk of a relapse.