Therapeutic challenge of a paediatric case of Graves' disease with severe ophthalmopathy

Description

An otherwise healthy girl aged 4 years was observed because of a 6-month history of tachycardia, polyphagia, chronic cough and agitation. Physical examination revealed hiperhydrosis, exuberant exophthalmia (figure 1) and a palpable, elastic and painless goitre. Laboratory work up showed an increased FT4, low thyroid-stimulating hormone (TSH) and positive thyrotropin receptor antibodies (TRABs) (figure 2), and thyroid ultrasonography demonstrated a diffusely heterogeneous, enlarged gland with no nodules, compatible with Graves' disease. The girl was initiated immediately to treatment with tiamazole (MTZ) and propranolol, and after few months, an euthyroid state was achieved and maintained until 2 years (figure 2). After this period, MTZ treatment was suspended and 1 month later, she returned with restless sleep and daytime agitation. Laboratory work up showed a TSH<0.005 μU/mL, T4L of 0.98 ng/mL and a positive TRABs and MTZ treatment (figure 2) was reintroduced.

http://ift.tt/2nwiMjE