​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.
Source: 1PubMed, 2Bluestone and Stool's Pediatric Otolaryngology, Volume 1
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, the immune system produces auto-antibodies against the thyroid gland. The most common antibody seen in Graves' Disease is Thyroid Receptor Antibody (TRAb). These auto-antibodies cause excessive release of thyroid hormones from the thyroid gland.
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, fast resting heart rate, increased blood pressure and irregular menses (for girls).
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 a medication (e.g. carbimazole) to reduce the free T4 levels. If there are symptoms of palpitations and high heart rate, a beta-blocker (e.g. propranolol) is given to alleviate these symptoms. When Graves' Disease is not well-controlled by carbimazole, second-line treatment may be offered, and may include radioactive iodine or surgery to remove the thyroid gland.
Close follow-up is required during treatment, including a series of blood tests. Some patients may achieve remission, meaning their thyroid function remains normal even after stopping carbimazole, although there is still a risk of relapse.
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