Clinical and laboratory findings at initial diagnosis in pediatric Graves' disease in Taiwan

We analyzed the clinical and laboratory data of 106 children (17 boys and 89 girls, 11.7 ± 3.4 years old) with newly diagnosed Graves' disease at Chang-Gung Children's Hospital in Taiwan from 1995 to 2005. The earliest age of disease onset was 3.36 years old, and incidence progressively increased throughout childhood, with a peak at 15 years old. Forty-six (48%) of 95 children had a positive family history of thyroid disorders. We divided the children into three groups according to pubertal stage: prepubertal (Tanner stage 1), 34 (32%); pubertal (Tanner stage 2-4), 13 (12%); and postpubertal (Tanner stage 5), 59 (56%). The most common presentations were diffuse goiter, heat intolerance, sweating, palpitations, and weight loss despite an increase in appetite, but there were no significant differences among the three groups. Neuropsychiatric symptoms such as nervousness, hyperactivity and poor school performance are common features in these children. Height standard deviation score (0.33 ± 1.35) revealed tall stature (0.39 ± 1.66 in the prepubertal group, -0.066 ± 0.63 in the pubertal group, and 0.40 ± 1.23 in the postpubertal group). Bone maturation also was accelerated in all three groups (bone age/chronological age 1.09 ± 0.22, 1.07 ± 0.20, and 1.08 ± 0.08), but there were no significant differences between groups. Body mass index (standard deviation score) was low in all three groups (-0.49 ± 1.10, -0.68 ± 0.63, and -0.13 ± 0.98), with no significant differences between groups. Tachycardia (96%), goiter (94%), fine tremor (92%), bruit (66%), hypertension (63%), and exophthalmos (60%) were the most frequent symptoms. Laboratory findings yielded undetectable TSH levels (<0.03 μIU/mL), increased FT4 (5.54 ± 2.26 ng/dL), TT4 (18.37 ± 4.79 μg/dL), and TT3 (450.4 ± 202.2 ng/dL), with no significant differences between groups. The prevalences of positive TBII, AMCA, and TGAB were 96%, 95%, and 71%, respectively. In conclusion, we did not find any differences in the presentation of Graves' disease among prepubertal, pubertal, and postpubertal patients. An awareness of symptoms is necessary for prompt diagnosis and management of Graves' disease because the disease can seriously interfere with children's growth and development.