Infantile Graves Disease

Abstract

Graves rsquo; disease is an autoimmune disorder presenting with hyperthyroidism and the disease is rare in childhood Two year old female patient was admitted to our clinic for her evident orbital puffiness Physical examination revealed propitosis tachycardia and a hyperpigmented spot with a diameter of 6x4 cm on the skin of the left hemithorax Evaluation of thyroid function tests showed the following values: fT4: 4 00 ng dl N: 0 8 1 9 fT3: 7 7 pg ml N: 1 57 4 71 TSH: 0 004 uIU ml N: 0 4 5 anti thyroglobulin: lt;20 IU mL N: 0 50 anti thyroid peroxidase: 45 7 IU mL N: 0 50 To distinguish Graves rsquo; disease and Mc Cune Albright syndrome TSH receptor antibody TRAb level and bone survey X ray were evaluated The TRAb level was 57 IU L N: 0 9 and there was no finding consistent with fibrous dysplasia on bone X rays Propylthiouracil was started with the diagnosis of Graves rsquo; disease In her clinical follow up propylthiouracil was switched to methimazole because of a potential risk of hepatotoxicity TRAb titers remained high and propitosis persisted There was no evidence of ophthalmopathy on orbital magnetic resonance imaging MRI In this report we described a case with Graves rsquo; disease who presented with propitosis because the disease and its ocular manifestations occur rarer in children compared to adults Mc Cune Albright syndrome was also discussed as a differential diagnosis Turk Arch Ped 2013; 48: 332 5

Keywords

• Graves’ disease, ophtalmopathy, thyrotoxicosis

Erken başlangıçlı Graves olgusu

Öz

Graves hastalığı otoimmün bir hastalık olup hipertiroidi ile seyreder ve çocukluk çağında nadir görülür İki yaşında kız hasta bir yıldır gözlerinin dışarıya doğru çıkık olması nedeniyle başvurdu Fizik bakısında propitoz taşikardi ve toraks sol ön duvarında orta klavikular hatta 6x4 cm çapında geniş bir adet hiperpigmente lekesi vardı Olgunun tiroid işlev testlerinden ST4: 4 00 ng dL N: 0 8 1 9 ST3: 7 7 pg mL N: 1 57 4 71 TSH: 0 004 uIU mL N: 0 4 5 anti tiroglobülin: lt;20 IU mL N: 0 50 anti tiroidperoksidaz: 45 7 IU mL N: 0 50 saptandı Mc Cune Albright ve Graves hastalığı ayırıcı tanısı açısından yapılan ileri tetkiklerinde tirotropin almaç antikoru TRAb :57 IU L N:0 9 saptandı ve çekilen tüm vücut iskelet grafilerinde fibröz displaziye rastlanmadı Hastaya Graves tanısıyla propiltiyourasil tedavisi başlandı İzlemde propiltiyourasile bağlı olası hepatotoksisite riski nedeniyle metimazole geçildi Tirotropin almaç antikoru pozitifliği ve propitozu devam eden olguya oftalmopati açısından orbita manyetik rezonans incelemesi yapıldı ve oftalmopati lehine bulgu saptanmadı Olgu bu yaş grubunda Graves hastalığının ender görülmesi erişkinlere oranla göz bulgularının çocuklarda çok daha nadir olması ve Mc Cune Albright sendromu ile ayırıcı tanı yapılması nedeniyle sunuldu Türk Ped Arfl 2013; 48: 332 5

Anahtar Kelimeler

• Graves, oftalmopati, tirotoksikoz

Kaynakça

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