Ophthalmic Findings in Pediatric Patients with Graves’ Disease—Single-Center Study

Background: Hyperthyroidism caused by Graves’ disease (GD) is a rare condition in the pediatric population. It is important to point out that GD is not just a thyroid disease, and Graves’ orbitopathy, also known as thyroid eye disease (TED), can develop. The aim of this study was to evaluate ophthalmologic status in pediatric patients with GD at a tertiary care referral center. Methods: Eighteen pediatric patients previously diagnosed with Graves’ disease received a complete ophthalmological exam, including exophthalmometry readings, clinical activity score (CAS) and ultrasound of extraocular muscles, and were graded according to the European Group on Graves’ Orbitopathy (EUGOGO) classification. General endocrine status, thyroid hormones (TSH, fT3, fT4, anti-Tg, anti-TPO and TSHRAb) and duration of disease were also collected. Results: The prevalence of TED in our cohort of children and adolescents with GD was 55.6%. The most common presentation was mild hyperemia (7 subject, 38%). After stratifying subjects according to clinical activity score, subjects with CAS ≥ 1 had a statistically greater MLPS-MRS muscle length compared to subjects with CAS 0. (4.64 ± 0.79 vs. 3.25 ± 0.95 vs., p = 0.001). Conclusions: This study provides the first study on the characteristics and prevalence of TED in Croatia; demonstrating TED prevalence and predominantly mild severity and clinical activity in children. Additionally, we would like to highlight the use of orbital ultrasonography as a safe, cost-effective, and reproducible method for assessing and monitoring pediatric TED.