BMJ Case Reports 2017; doi:10.1136/bcr-2017-219269

Therapeutic challenge of a paediatric case of Graves' disease with severe ophthalmopathy

  1. Ana Antunes3,4
  1. 1Department of Pediatrics, Hospital Sra da Oliveira Guimarães, Guimarães, Portugal
  2. 2Department of Endocrinology, Hospital de Braga, Braga, Portugal
  3. 3Pediatric Endocrinology Unit, Hospital de Braga, Braga, Portugal
  4. 4Pediatric Department, Hospital de Braga, Braga, Portugal
  1. Correspondence to Dr Ana Antunes, ana.antunes.p{at}
  • Accepted 28 February 2017
  • Published 16 March 2017


An otherwise healthy girl aged 4 years was observed because of a 6-month history of tachycardia, polyphagia, chronic cough and agitation. Physical examination revealed hiperhydrosis, exuberant exophthalmia (figure 1) and a palpable, elastic and painless goitre. Laboratory work up showed an increased FT4, low thyroid-stimulating hormone (TSH) and positive thyrotropin receptor antibodies (TRABs) (figure 2), and thyroid ultrasonography demonstrated a diffusely heterogeneous, enlarged gland with no nodules, compatible with Graves' disease. The girl was initiated immediately to treatment with tiamazole (MTZ) and propranolol, and after few months, an euthyroid state was achieved and maintained until 2 years (figure 2). After this period, MTZ treatment was suspended and …

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