# Graves’ disease in Children: A Case Report of Rare Occurrence

## TL;DR

A four-year-old girl with rare Graves’ disease showed persistent symptoms despite treatment, highlighting the need for long-term care in young children.

## Contribution

This case report highlights the rare occurrence and management challenges of Graves’ disease in preschool-aged children.

## Key findings

- The patient showed persistent elevated TRAb levels and suppressed TSH despite initial treatment with carbimazole and propranolol.
- Long-term antithyroid drug therapy is necessary, with definitive treatment considered if remission is not achieved after three years.
- The case emphasizes the importance of individualized treatment and prolonged monitoring in young children with Graves’ disease.

## Abstract

Graves’ disease (GD) is an autoimmune disorder that manifests as goiter, weight loss, heat intolerance, and palpitations. It is rare in preschool-aged children (<5 years) and can lead to serious acute and long-term complications, including growth and development, if left undiagnosed.

We present the case of a four-year-old Hindu Asian girl from a low socioeconomic background who presented with progressive thyroid enlargement and symptoms of excessive sweating, heat intolerance, weight loss, diarrhea, fatigue, and palpitations over six months. Examination revealed symmetrical goiter, signs of thyrotoxicosis, bilateral exophthalmos, and raised blood pressure. Laboratory investigations confirmed Graves’ disease with suppressed TSH, elevated T3 and free T4, and persistently high TSH receptor antibodies (TRAb >40 IU/L). She was started on carbimazole and propranolol, resulting in clinical improvement; however, biochemical parameters, including TRAb levels, remain persistently elevated at eight months and suppressed TSH at 13 months, indicating a high risk of relapse. Long-term ATD therapy will be continued, with definitive treatment (RAI or thyroidectomy) considered if remission is not achieved after three years. This case underscores the challenges of managing Graves’ disease in young children and the need for prolonged monitoring and individualized treatment strategies.