Important considerations when choosing pharmacotherapy for Graves’ disease in children

Abstract

Graves’ disease (GD) is an autoimmune disorder in which hyperthyroidism and thyroid enlargement are caused by TSH receptor antibodies stimulation. It is the most common cause of hyperthyroidism in iodine-replete populations with prevalence between 0.5% and 2%, and ten times more common in women than in men. GD is typically diagnosed in middle-aged persons with the peak age-specific incidence between 20 and 49 years, but the first clinical presentation is possible also in elder patients as well as in children, especially during adolescence. As in adults, GD is the major cause of hyperthyroidism in children, much more frequent in girls than in boys, although it is a rare clinical problem among pediatric patients who constitute only 1–5% of all patients with GD. In pediatric population, the frequency of GD is higher when associated with coexisting autoimmune diseases or genetic ones like Down syndrome, Turner syndrome or Di George syndrome as well as in families with a history of autoimmune thyroid disorders. Some environmental factors like iodine excess (for example mandatory salt iodination), infectious diseases, smoking, alcohol, stress, selenium status, dioxins, or radiation exposure are discussed as associated with increased risk of GD in children [1–4]. While discussing important considerations when choosing optimum treatment option for GD in children, one should realize the differences referring to course of GD and response to treatment in pediatric population as detailed below.