Clinical course of Graves’ orbitopathy in children with newly diagnosed hyperthyroidism: a prospective observational study

OBJECTIVES: Although Graves' orbitopathy (GO) in childhood is generally considered milder than in adults, data regarding its clinical course and relationship with thyroid autoimmunity remain limited. This study aimed to evaluate the frequency and clinical characteristics of GO in pediatric patients with newly diagnosed hyperthyroidism and to assess short-term changes in ocular findings during follow-up. METHODS: In this prospective observational study, 24 children with hyperthyroidism were enrolled. All ophthalmologic examinations were performed by the same ophthalmologist. Ocular findings were assessed according to the 2021 EUGOGO criteria, and disease activity was determined using the Clinical Activity Score (CAS). Thyroid function tests and autoantibodies, including anti-thyroid peroxidase antibody, thyrotropin receptor antibody, and thyroid-stimulating immunoglobulin, were evaluated at baseline and at 6 months. Associations between clinical, biochemical, and ophthalmologic parameters were analyzed statistically. RESULTS: The mean age was 14.1 ± 3.4 years, and 75 % of patients were female. At baseline, 83.3 % had mild GO and 16.7 % had moderate-to-severe disease. CAS values were <3 at both time points in all patients, and no active orbitopathy was observed. Hertel measurements showed no significant changes during follow-up. Significant reductions in anti-thyroid peroxidase antibody, thyrotropin receptor antibody, and thyroid-stimulating immunoglobulin levels were observed at 6 months. Baseline Hertel values correlated positively with thyrotropin receptor antibody levels. Beta-blocker requirement decreased from 66.7 % at baseline to none at 6 months. Only one patient (4.2 %) showed transient progression in EUGOGO severity. CONCLUSIONS: In pediatric hyperthyroidism, GO is usually mild and inactive, with rare short-term clinical progression. Despite marked improvement in thyroid autoimmunity, ocular findings remained largely stable. These results support the generally benign course of childhood GO and emphasize the importance of detailed ophthalmologic assessment at diagnosis.