Clinical features of the course of Graves' disease in children

Aim. To evaluate the features of the course and treatment of Graves' disease in children at the present stage.

Materials and methods. Thirty two children diagnosed with Graves' disease aged 5.5 to 16.5 years were examined; 19 girls and 5 boys were admitted to the department for the first time, 6 girls and 2 boys with relapses of the disease. The duration of the disease in these children ranged from 2 to 8 years, the number of relapses was from 2 to 4, the intervals for the onset of relapse of the disease ranged from 6 months to 2 years. The examination algorithm included the study of the anamnesis of life and disease, the assessment of objective data. Thyroid ultrasound was performed on a GE Healthcare Medical Systems Vivid machine. The level of thyroid hormones was determined: triiodothyronine, thyroxine, thyroid-stimulating hormone (TSH), the level of antibodies to the microsomal fraction with the IMMULITE 2000 XPi and ARCHTESTo2000SR kits (Siemens, Abbott, Germany) and antibodies to the TSH receptor with the ARCHTESTo2000SR kits (Abbott, USA).

Results. During an objective examination, tachycardia was determined in all children, an increase in the thyroid gland was noted. Almost all children had eye symptoms. The level of thyroid hormones was elevated in all children, both newly diagnosed and those admitted with a relapse of the disease. The level of TSH in all patients was reduced. The antibody titer was high for both the microsomal fraction and the TSH receptor. All patients admitted for the first time were prescribed drug therapy with thyreostatics. Three out of eight children with a recurrence of the disease were referred for radioactive iodine treatment and 1 for surgical treatment. The remaining four children continued drug treatment with thyreostatics, due to the parents' disagreement with other methods of treatment.

Conclusion. Thus, despite the pronounced manifestations of Graves' disease, almost all children had a late diagnosis of the disease: from the moment the complaints appeared to the diagnosis and start of treatment, it took from 4 months to 1 year. Initially, the children were treated and treated by specialists in various fields. Relapses of the disease, as a rule, developed after discontinuation of therapy, either after the end of the recommended treatment period (2 years), or at different times, due to self-cessation of treatment. In some patients, unreasonably long treatment with thyreostatics was noted, despite the development of: 3–4 relapses of the disease and the ineffectiveness of conservative therapy.