Clinical Characteristics and Risk Factors of Pediatric Thyroid Eye Disease

Purpose: To characterize the natural history and clinical characteristics of thyroid eye disease (TED) in a pediatric population and identify risk factors contributing to disease onset and severity. Methods: A retrospective cohort study was conducted among children diagnosed as having TED between 2013 and 2023 presenting to Texas Children's Hospital. Patient demographics, ocular examination findings, disease progression, and management were recorded across encounters. Descriptive statistical analyses, Mann-Whitney U test, and chi-square test were performed. Results: Seventy-eight patients met the inclusion criteria. The mean age of children at the time of TED diagnosis was 11.1 ± 3.8 years. Most children with TED were female (78.2%), White (66.7%), non-Hispanic or Latino/a (59.0%), and hyperthyroid (85.5%), and had a family history of autoimmune disease (57.1%). Patients had their initial ophthalmology visit 0.9 years after the onset of thyroid disease symptoms on average. A higher Clinical Activity Score (CAS) was recorded in patients with autoimmune comorbidities ( P < .05). Conclusions: Children with an autoimmune comorbidity are more likely to present with more severe TED. Trends in CAS values across time are heterogenous in the pediatric sample, with the most common trend of decreasing CAS across encounters, although with limitations in the availability of documented CAS values. Children with TED typically follow a non-progressive clinical course without requiring surgical intervention but may face greater delays in receiving timely ophthalmic care for their symptoms.