Clinical Pattern of Graves’ Disease and Management Preferences Among Pediatric Endocrinologists in Saudi Arabia, A Decade of Experience

Background: Graves’ disease (GD) ranks as a primary cause of hyperthyroidism across all age demographics. The clinical presentation, treatment approaches, and overall therapeutic objectives can differ among various age groups. This study aimed to describe the clinical, laboratory, and radiological features, as well as the outcomes of the management of GD within the Saudi pediatric population. Methods: A cross-sectional, multicenter study across 2 tertiary care centers in Saudi Arabia (2010-2021). Clinical, biochemical, and imaging data were collected for children diagnosed with hyperthyroidism under the age of 18, utilizing an electronic medical records system. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: We enrolled 93 patients with hyperthyroidism (Mean age at diagnosis = 11.5 years; females = 68, 73.1%). Notably, 40/93 patients (43%) had a significant family history. The primary etiologies were GD (N = 60, 64.5%) and hashitoxicosis (N = 10, 10.8%). The commonest presentations were goiter (57%) and tachycardia (55%). GD was predominantly associated with exophthalmos, lid lag, sweating, tremors, and weight loss (Odds Ratios = 3.71, 3.8, 2.77, 2.34, and 2.28, respectively). An increase in thyroid radioactive iodine uptake was observed in 29/93 patients (48.3%; P -value = .029), in contrast to non-sensitive thyroid ultrasound results ( P -value = .228). Thyroid Stimulating Immunoglobulin (TSI; N = 9.1, P -value = .000), Anti-thyroglobulin (TG; N = 537.5, P -value = .018), and Anti-thyroid peroxidase (TPO; N = 366.5, P -value = .017) were significant alongside FT4 and FT3 ( P -value = .000) in diagnosing GD. Most patients were treated exclusively with methimazole (MMT), showing good compliance (N = 44, 73%) and minimal adverse effects (N = 56, 93.3%). Radioactive iodine (RAI) ablation was performed in 14 patients (23.3%), and thyroidectomy in 5 patients (8.3%). Conclusion: In our cohort, GD emerged as a leading cause of hyperthyroidism among children and adolescents. Pediatric endocrinologists in Saudi Arabia tend to underutilize RAI and prefer alternative treatment methods.