Graves Disease in Children

Graves disease is an autoimmune disease. The immune system normally protects the body from germs with chemicals called antibodies. But with an autoimmune disease, it makes antibodies that attack the body’s own tissues. With Graves disease, antibodies cause the thyroid gland to make too much thyroid hormone. This is known as hyperthyroidism. Excess thyroid hormone in the bloodstream leads to the body's metabolism being too active. It can cause problems such as weight loss, nervousness, fast heartbeat, tiredness, and other issues. It’s an ongoing (chronic) condition that needs lifelong treatment.

Graves disease may be caused by any of these:

• Genes passed down in families
• Viral infections
• Stress
• Smoking
• Medicines that contain iodine

A child is more at risk for Graves disease if he or she has any of the below risk factors: 

• Being female
• Family history of Graves disease or other autoimmune conditions
• Use of medicines that have iodine
• History of smoking

The signs of Graves disease may be different in children than in adults. Signs can occur a bit differently in each child. They can include:

• An enlarged thyroid gland in the front of neck (goiter) 
• Trouble swallowing
• Bulging eyes
• Weight loss or poor weight gain despite increased appetite
• Fast heartbeat, increased blood pressure
• Increased sweating
• Poor sleep
• Changes in menstrual periods
• Hair loss
• Weakness
• Tiredness (fatigue)
• Irritability and mood swings
• Trouble concentrating
• Emotional outbursts such as crying or yelling
• Fast growth rate that slows early and may lead to short height
• Graves disease can be harder to diagnose in kids who are normally active. A parent may mistake a child’s behavior for hyperactivity or a psychiatric condition.

The symptoms of Graves disease can be like other health conditions. Make sure your child sees his or her healthcare provider for a diagnosis.

The healthcare provider will ask about your child’s symptoms and medical history. He or she may also ask about your family’s medical history. He or she will give your child a physical exam. Your child may also have blood tests. These check for:

• Thyroid-stimulating hormone (TSH). A low level of TSH may mean hyperthyroidism.
• Certain antibodies. Another blood test checks for antibodies that attach to proteins from the thyroid gland. High levels of these antibodies may mean Graves disease. Or it may mean another autoimmune thyroid disease.

Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Treatment may be done with:

• Anti-thyroid medicine. These types of medicine help to block the production of thyroid hormone. Your child may be given methimazole or propylthiouracil. Propylthiouracil is not often used first due to the risk of side effects.
• Radioactive iodine. This may be used if your child has a serious reaction to anti-thyroid medicines, or if the medicine doesn't help stop symptoms. This oral medicine destroys part or all of the thyroid gland. This blocks the production of thyroid hormone.
• Thyroidectomy. This is a surgery to remove all or part of the thyroid. Surgery may be done in children who have not reacted well to anti-thyroid medicines or radioactive iodine. After the surgery, your child will likely need to take thyroid hormones to avoid low thyroid hormone (hypothyroidism) symptoms.

Some people with Graves disease develop an eye condition known as Graves ophthalmopathy. This is when the immune system attacks muscles and tissues around the eyes. 

Side effects from the medicines used to treat Graves disease can also occur. If you have concerns about complications from Graves disease, talk with your child’s healthcare provider.

It may take time to find the right treatment for your child. It can take time to find the correct dose of medicine or to decide to try another treatment. The process of finding the right treatment can be stressful for children and parents. Make sure to watch your child for any signs of Graves that return.

Graves disease is a lifelong condition. Talk with your child’s healthcare provider about support groups for you and your child. Talk with your child’s school about your child’s condition. Graves disease can cause problems with performance in school. Your child may benefit from changes to his or her learning plan. He or she may be covered by the Individuals with Disabilities Education Act of 1997 and Section 504 of the Rehabilitation Act of 1973. Your child's healthcare provider and school staff can give you more information about these laws.

Call your child’s healthcare provider if you think your child has signs of Graves disease. 

If your child is being treated for Graves disease, call the healthcare provider if your child has signs of Graves that come back.

• Graves disease is an autoimmune disease. With Graves disease, antibodies cause the thyroid gland to make too much thyroid hormone. This is known as hyperthyroidism.
• Excess thyroid hormone in the bloodstream leads to the body's metabolism being too active. It can cause problems such as weight loss, nervousness, fast heartbeat, tiredness, and other issues.
• Graves disease is an ongoing (chronic) condition that needs lifelong treatment.
• Graves disease can be harder to diagnose in kids who are normally active. A parent may mistake a child’s behavior for hyperactivity or a psychiatric condition.
• Treatment may be done with anti-thyroid medicine or radioactive iodine. In some cases, surgery may be needed to remove all or part of the thyroid gland.
• It may take time to find the right treatment for your child. It can take time to find the correct dose of medicine or to decide to try another treatment.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.