A case of infantile-onset Graves

Graves rsquo; disease is an autoimmune disorder presenting with hyperthyroidism and the disease is rare in childhood Two year old female patient was admitted to our clinic for her evident orbital puffiness Physical examination revealed propitosis tachycardia and a hyperpigmented spot with a diameter of 6x4 cm on the skin of the left hemithorax Evaluation of thyroid function tests showed the following values: fT4: 4 00 ng dl N: 0 8 1 9 fT3: 7 7 pg ml N: 1 57 4 71 TSH: 0 004 uIU ml N: 0 4 5 anti thyroglobulin: lt;20 IU mL N: 0 50 anti thyroid peroxidase: 45 7 IU mL N: 0 50 To distinguish Graves rsquo; disease and Mc Cune Albright syndrome TSH receptor antibody TRAb level and bone survey X ray were evaluated The TRAb level was 57 IU L N: 0 9 and there was no finding consistent with fibrous dysplasia on bone X rays Propylthiouracil was started with the diagnosis of Graves rsquo; disease In her clinical follow up propylthiouracil was switched to methimazole because of a potential risk of hepatotoxicity TRAb titers remained high and propitosis persisted There was no evidence of ophthalmopathy on orbital magnetic resonance imaging MRI In this report we described a case with Graves rsquo; disease who presented with propitosis because the disease and its ocular manifestations occur rarer in children compared to adults Mc Cune Albright syndrome was also discussed as a differential diagnosis Turk Arch Ped 2013; 48: 332 5