Clinical features and treatment of Graves ophthalmopathy in pediatric patients

Purpose: To determine the clinical characteristics and review the frequencies of medical and surgical treatment of children with Graves ophthalmopathy. Methods: Retrospective case series identifying patients 18 years or younger in whom Graves ophthalmopathy was diagnosed from 1985 through 1999. Data also were obtained from a follow-up survey. Results: The 35 children with Graves oplithalmopathy included 27 girls (77.1%) and 8 boys (22.9%). At the time of initial ophthalmic examination, 31 patients (88.6%) were hyperthyroid, 1 (2.9%) was hypothyroid, and 3 (8.6%) were euthyroid. The mean age at diagnosis of thyroid dysfunction was 13.1 years (range. 3 to 18). The mean age at diagnosis of ophthalmopathy was 15.0 years (range, 5 to 18). No patient had compressive optic neuropathy. Thirty-one patients (88.6%) required no therapy or only supportive therapy. One patient (2.9%) required eyelid surgery and 3 (8.6%) underwent transantral orbital decompression for proptosis that caused discomfort and exposure keratitis. No patient received systemic corticosteroids or orbital radiotherapy. A follow-up survey was returned by 20 respondents at a mean follow-up of 11.0 years after the initial examination (range, 3.4 to 19.4). One patient (5.0%) had undergone eye muscle surgery. All patients stated that their vision was good, and 19 (95.0%) had no diplopia. Two patients (10.0%) reported that family members had Graves ophthalmopathy, and 12 (60.0%) had family members with thyroid dysfunction. Conclusions: The clinical manifestations of Graves ophthalmopathy are relatively less severe in pediatric patients. Surgical therapy is infrequently necessary.