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Graves’ disease is an autoimmune condition and the most common cause of hyperthyroidism in children and adolescents.

Autoimmune diseases occur when the body’s immune system starts to produce antibodies that target areas of the body that it shouldn’t. The antibodies in Graves’ disease primarily target the thyroid gland. In response to these antibodies, the thyroid gland becomes overactive and starts to produce too much thyroid hormone. This results in high levels of thyroid hormone, which is called hyperthyroidism. If left untreated, hyperthyroidism can lead to other health problems.

The most common age for detection of overactive thyroid in childhood is between 9 and 15 years of age, but it can occur in a younger child, although it is uncommon under the age of 3.

Symptoms of hyperthyroidism include:

• Feeling too hot
• Increased sweating
• Muscle weakness
•  Shaky hands
•  Rapid heartbeat
•  Fatigue/fatigue
•  Weight loss
•  Diarrhea or frequent bowel movements
•  Irritability and anxiety
•  Eye problems, such as irritation or discomfort
• Menstrual irregularities

The disease can also cause swelling behind the eyes that sometimes makes them bulge outward. This condition is called thyroid ophthalmopathy.

How is it diagnosed?

Your pediatric endocrinologist will review your child’s history and growth charts. They will also check for thyroid gland enlargement, eye irritation, blood pressure, and/or signs of hand tremors. They may need to do the following tests:

• Thyroid hormone levels. Very low TSH levels and high T4 and T3 levels in your blood indicate hyperthyroidism.
• Check for antibodies against the thyrotropin receptor that cause Graves’ disease.
• Radioactive iodine uptake test. This test involves swallowing a capsule containing a small, harmless amount of radioactive iodine. The amount of iodine taken up by your thyroid is then measured. High uptake of radioactive iodine suggests Graves’ disease.
• Thyroid ultrasound: A thyroid gland affected by Graves’ disease is often enlarged and may have increased blood flow. Both of these findings are seen on a thyroid ultrasound. The ultrasound may also be done if there is concern about a nodule that is producing thyroid hormones.

How is a child with Graves’ disease treated?

The disease is treatable and can be well controlled. Some patients may go into remission, but many require long-term treatments for this condition.

A variety of treatments are available, including:

• Antithyroid drugs: These drugs reduce the amount of hormone the thyroid produces.
• Radioactive iodine: This treatment is usually given in higher doses than in the radioactive iodine uptake test. Radioactive iodine treats hyperthyroidism from Graves’ disease in the majority of patients. Radioactive iodine works by slowly destroying the overactive thyroid gland, and therefore patients may need thyroid hormone supplementation.
• Surgery: Removing the thyroid gland through surgery is a permanent solution, but it is usually not preferred due to the risk of damage to the nearby parathyroid glands and nerves in the throat. Surgery is recommended when antithyroid medication and radioactive iodine therapy may not be tolerated or appropriate.
• Beta-blockers: Beta-blockers can control many symptoms, especially rapid heart rate, tremors, and anxiety.