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- When to suspect thyroid - associated orbitopathy in children?
Thyroid-associated orbitopathy (TAO) should be considered in a child who
presents with proptosis, which is usually bilateral and asymmetrical, along
with diffuse goiter and thyrotoxicosis. However, the unusual presentation of
TAO includes unilateral proptosis and euthyroid TAO, and rarely 3–5 % of
patients may have TAO associated with Hashimoto’s thyroiditis. Elevated
TSH receptor antibodies (TRAb) titer substantiates the diagnosis of TAO,
which may be particularly useful in euthyroid TAO. Extraocular muscle belly
thickening with sparing of tendon is characteristic radiological fi nding in
TAO.- How to treat a child with Graves ’ disease?
The available treatment modalities for the management of Graves’ disease in
children include antithyroid drugs, radioactive iodine, and thyroid surgery.
Among the antithyroid drugs, methimazole/carbimazole is preferred as there is
a higher risk of hepatotoxicity with the use of propylthiouracil in children.
Methimazole is initiated at a dose of 0.25–1 mg/Kg/day as a single daily dose.
Addition of propranolol at a dose of 0.5–2 mg/Kg/day in three divided doses
helps in alleviation of adrenergic manifestations. The response to antithyroid
drugs is poor in children as compared to adults, and only 20–30 % of children
achieve remission after 2 years of therapy. Further, predictors of remission of
Graves’ disease are not well defi ned in children. It is recommended that chil-Fig. 3.21 Siblings with diffuse goiter and stare suggestive of familial Graves’ disease. They
showed positivity for TSH receptor antibody (TRAb)
3 Thyroid Disorders in Children