Pediatric graves' orbitopathy: a case series of 136 Chinese patients.

Abstract

Purpose: To determine the clinical features and treatment methods of pediatric patients with Graves' orbitopathy (GO).

Methods: We analyzed 136 GO patients aged 18 or younger at West China Hospital from January 2009 to November 2023, recording symptoms, clinical characteristics, treatments, and prognosis.

Results: Patients' ages ranged from 2 to 17 years, with 83.82% being female, mostly at Tanner stage four. Initially, 86.03% had hyperthyroidism. The most common symptom was exophthalmos (90.44%), and the main signs were lid lag (90.46%), eyelid swelling (59.75%), and upper eyelid retraction (53.11%). Females had more exophthalmos and lid lag (p = 0.010, 0.015; t = 2.620, 4.238). Imaging showed 46.97% had no extraocular muscle affected. The most affected muscles were the inferior rectus (44.7%), superior rectus (28.03%), medial rectus (21.21%), and lateral rectus (20.45%). Only six eyes were at the active stage, 65.56% had mild severity, and none were sight-threatening. No treatment was given to 51.87% of patients, while 41.49% received periorbital corticosteroid injections. Two patients had injections plus radiotherapy, and one had injections, radiotherapy, and glucocorticoid pulse therapy. Severity and activity decreased significantly in the treatment group (p < 0.001), while non-treatment group exhibited a significant decrease in severity (p = 0.022).

Conclusions: Pediatric GO patients, mainly late-stage pubertal females, had less severe symptoms and better prognoses than adults. Observation is often sufficient, with periorbital corticosteroid injections being effective when necessary.