Neuro-Psychiatric Onset of Graves’ Disease in Children. Case Report and Literature Review (original) (raw)

The Medical-Surgical Journal, 2019

Abstract

Children with thyrotoxicosis are usually hyperactive with behavioral problems, difficulty in concentration and attention. Neuro-psychiatric disturbances in children with Graves’ disease (GD) can be mistaken for “true” psychiatric or neurologic disorder delaying the diagnosis and the correct therapeutic approach. We present the case of an 8 years old with important height and weight gain in the last two years. The patient had a medical history of ADHD. Despite the psychotherapy the behavior has not improved. Physical examination revealed increased weight and height, exophthalmia and lid retraction, diffuse goiter, important tremor, hyper talkativeness, warm and moist palms and tachycardia. The diagnosis of GD was confirmed by the values of thyroid hormones and the presence in high titers of thyroid stimulating hormone receptor antibodies (TRAb). After several months of treatment with ATDs only, we have switched “on block and replace” therapy. During the 3 years surveillance, the height and weight velocity rates remained increased with an advanced bone age. Once euthyroidism achieved and maintained, also the neuropsychiatric abnormalities, including irritability, anxiety, sleep disturbances and mood changes improved. The school performances improve to, and the inability to concentrate disappeared after several months. At the moment the patient is still on a minimal dose of ATD with normal hormonal levels. Neuro-psychiatric manifestations can be the first sign of thyrotoxicosis in children and adolescents. A close collaboration with parents is required in order to have the desired results: euthyroidism and disappearance of neuro-psychiatric dysfunctions.

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