Graves Disease in Children

What is Graves disease in children?

Graves disease is an autoimmune disease. The immune system normally protects the body from germs with proteins called antibodies. But with an autoimmune disease, the antibodies 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 causes the body's metabolism to be too active. This can lead to problems, such as weight loss, nervousness, fast heartbeat, tiredness, and other issues. Graves disease is an ongoing (chronic) condition that needs lifelong treatment or watching.

What causes Graves disease in a child?

Graves disease is much less common in children than in adults, but it does increase in frequency during puberty, especially in females. With this disease, the body makes antibodies against itself that cause the thyroid gland to grow and to make too much thyroid hormone.

Which children are at risk for Graves disease?

A child is more at risk for Graves disease if they have any of the following risk factors: 

• Being female, especially after puberty

• Family history of Graves disease or other autoimmune conditions

• Use of iodine or medicines that have iodine

• Stress

• Viral infections

• History of smoking

• Down syndrome or Turner syndrome

What are the symptoms of Graves disease in a child?

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 not enough weight gain even with an increased appetite

• Fast heartbeat, increased blood pressure

• Increased sweating

• Inability to tolerate warm weather

• Trouble sleeping

• Changes in menstrual periods

• Hair loss, especially scalp hair

• Weakness

• Tiredness (fatigue)

• Irritability, nervousness, and mood swings

• Trouble concentrating

• Emotional outbursts, such as crying or yelling

• Fast growth rate that slows early and may lead to short height

• Increased urination or bowel movements, bed-wetting

Graves disease can be harder to diagnose in children who are normally or only mildly hyperactive. 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 their healthcare provider for a diagnosis.

How is Graves disease diagnosed in a child?

The healthcare provider will ask about your child’s symptoms and medical history. They may also ask about your family’s medical history. Your child will have a physical exam and get blood tests to check for:

• Thyroid-stimulating hormone (TSH). A low level of TSH may mean hyperthyroidism.

• Free thyroxine (FT4) and triiodothyronine (T3). These are thyroid hormones that circulate in the blood.

• Some types of antibodies. Blood tests check for antibodies against the thyroid gland that may mean Graves disease or other autoimmune diseases.

How is Graves disease treated in a child?

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

• Anti-thyroid medicine. This type of medicine helps to block the production of thyroid hormone. Your child may be given a medicine known as methimazole. Propylthiouracil is also effective but is not often used because it can cause side effects, including liver failure.

• Radioactive iodine. This may be used if your child has a serious reaction to antithyroid medicines, or if the medicine doesn't help stop the 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 antithyroid medicines or radioactive iodine. After the surgery, your child will likely need to take thyroid hormones for life to prevent low thyroid hormone (hypothyroidism) symptoms.

What are possible complications of Graves disease in a child?

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, causing problems with eye motion and eye bulging.

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.

How can I help my child live with Graves disease?

Finding the right treatment for your child may not be easy. 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 disease that may return.

Graves disease is a lifelong condition. Talk with your child’s healthcare provider about support groups for you and your child. Graves disease can also cause problems with performance in school. Talk with your child’s school about your child’s condition. Your child may benefit from changes to their learning plan. Your child 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.

When should I call my child's healthcare provider?

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, or if your child may be having side effects from the treatment.

Key points about Graves disease in children

• 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 causes the body's metabolism being too active. It can lead to 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 include antithyroid medicine or radioactive iodine. In some cases, surgery may be needed to remove all or part of the thyroid gland.

• Finding the right treatment for your child may not be easy. It can take time to find the correct dose of medicine or to decide to try another treatment.

Next steps

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 directions 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.