Graves' Disease

Graves' disease presents itself as a type of thyroid Disease; however, it is an autoimmune disorder. An autoimmune disorder occurs when the immune system mistakenly attacks the body's own cells and tissues. When the immune system attacks these otherwise healthy tissues, illness can develop.

Pediatric Graves' disease can be life-threatening, and it adversely alters growth and development. There is no cure for Graves' Disease, but with treatment children can live long, happy, full lives.

Since thyroid disease in children is rare, it makes the occurrence of pediatric Graves' disease extremely rare. Graves' disease accounts for about 15% of all cases of pediatric hyperthyroidism, and pediatric Graves' disease accounts for about 5% of all cases of Graves' disease.

Risk Factors:

Graves' disease is more prevalent in females than in males; therefore, hormone levels may play a part in the initiation of the disease. The onset of graves' disease is often preceded by a traumatic event. This means that stress may also play a role in the initiation of the disease.

Symptoms

• A swelling of the thyroid gland (goiter)
• Tachycardia (a rapid heart rate)
• Arrhythmia (irregular heart beat)
• High blood pressure
• Shortness of breath
• Unexplained weight loss/inability to gain weight
• Intolerance to heat
• Increased sweating
• Increased appetite
• Frequent bowel movements
• Sinus infections
• Restlessness/nervousness
• Increased energy
• Fatigue
• Insomnia
• Erratic behaviour
• Mood swings/'rages'
• Difficulty concentrating/short attention span
• Trembling in the hands or fingers
• Pretibial Myxedema (Lumpy, reddish skin of the lower legs)
• Sweaty palms
• Muscle weakness (especially in the large muscles of the arms and legs)
• Eye pain, irritation, or the feeling of grit or sand in the eyes
• Swelling or redness of eyes or eyelids/eyelid retraction
• Sensitivity to light
• Exophthalmos (Protrusion of one or both eyes past the protective orbit)
• Blurred/double vision

The Thyroid Gland

thyroid gland the largest of the endocrine glands, consisting of two lateral lobes connected by an isthmus, with a third pyramidal lobe sometimes extending up from the isthmus. The gland is located in the front and sides of the neck just below the thyroid cartilage. It produces hormones that are vital in maintaining normal growth and metabolism , and it also serves as a storehouse for iodine.

Important Thyroid-Related Hormones

• TSH Thyroid Stimulating Hormone; secreted by the pituitary gland. Stimulates the thyroid, causing it to release thyroid hormones.
• T3 Triiodothyronine; a less abundant but more potent thyroid hormone. Aids in regulating metabolism and heart rate.
• T4 Thyroxine; the most important thyroid hormone. Processes iodine in the thyroid, affects mitochondrial activity, regulates protein synthesis and breakdown and carbohydrate metabolism. This hormone stimulates the central nervous system and the endocrine system, and remains active in the body for up to a month. Too much thyroxine can cause over-stimulation of the nervous/endocrine systems as well as increased metabolism.
• Iodine; An important element necessary for healthy thyroid functioning. Too much stored iodine in the thyroid is a sign of hyperthyroidism. Iodine deficiency or allergy can result in a goiter (swollen thyroid gland).

Graves' disease is most often associated with hyperthyroidism. It is believed that it is caused by an antibody which stimulates the thyroid too much, in turn causing the excess production of thyroid hormone. The disease tends to run in families, and is most common in young to middle-aged women. Graves' Disease is classified as an Autoimmune Disease. It has all the same symptoms as Hyperthyroidism with 3 additional ones, which are

• bulging eyes (exophthalmos)
• goiter (enlarged thyroid)
• thickened skin over the shin area

Treatments For Graves' Disease

• Antithyroid drugs, which help lower the level of thyroid hormones in the blood.
• Radioactive iodine, in the form of a pill or liquid, which damages thyroid cells so that production of thyroid hormones is slowed down.
• surgery to remove part or all of the thyroid.
• Beta-blockers, which block the action of thyroid hormone on the body (these drugs do not change the levels of thyroid hormone in the blood.

The modalities of treatment for children and adults are the same, namely antithyroid drugs, radioiodine treatment or surgery. Many pediatricians initiate treatment with antithyroid drugs and if improvement is not seen, another modality is chosen. Antithyroid drugs are usually not given long term to children since only 30-40% of children respond. In addition, the side effects in children can be severe, and the relapse rate of Graves' disease is high. Studies also indicate that the risk of thyroid carcinoma in children and adolescents increases with time and is higher following antithyroid treatment than following radioiodine treatment. Some children are best managed by removing the thyroid gland once the hyperthyroidism is under control.

Radioiodine treatment does not thus far appear to cause any increase in the risk of thyroid carcinoma in children and adolescents. Further investigation regarding long-term outcomes is needed. Some doctors prefer to consider RAI as an option for failed antithyroid drugs before they consider surgery.

In children, surgery may be considered under the following conditions:

• Large thyroid gland
• Severe Graves' ophthalmopathy
• Poor response to antithyroid drugs

The success rate of thyroidectomy in children has been estimated at approximately 95%. There is ongoing debate regarding the long-term advantages of total versus subtotal thyroidectomy in children and adolescents. As with adults, the success of surgery is highly dependent on the skill of the surgeon. Complications of surgical thyroidectomy, (e.g., hypoparathyroidism and laryngeal nerve injury) are estimated at approximately 4%.

When subtotal thyroidectomy is performed on children, the remnant left in the patient is usually smaller than that of an adult patient because the risk of recurrence of hyperthyroidism is higher than for an adult. With the minimal thyroid tissue left in children, the risk of recurrence is reduced to approximately 10% and the risk of developing hypothyroidism is approximately 40%.

With RAI and thyroidectomy, permanent hypothyroidism is common and requires life long thyroid replacement therapy.

Complications

Thyroid storm

Thyroid storm is a severe, life-threatening condition caused by an excess of thyroid hormone. A number of factors can be involved in causing thyroid storm, including over-replacement of thyroid hormones or discontinuing medications taken to treat hyperthyroidism.

Symptoms of thyroid storm can include,

• fever (potentially as high as 105-106 degrees F),
• racing pulse
• nausea
• vomiting
• diarrhea
• irregular heart beat
• confusion
• weakness

Thyroid storm can lead to heart failure and requires emergent medical treatment.

Nutrition

Foods that may interfere with thyroid function

• broccoli
• cabbage
• brussels sprouts
• cauliflower
• kale
• spinach
• turnips
• soy
• beans
• mustard greens
• Absolutely No Shellfish

Also avoid refined foods, dairy products, wheat, and caffeine.

Activity

Use your best judgement, when it comes to activity. Until your child's heart rate and blood pressure is under control, limit their activity. No running, bike riding, anything that will raise the heart rate even more. If need be ask your child's doctor for a note excusing her or him from recess and or Physical Education, until your child's heart rate and blood pressure are regulated. You know what's best for your child, and there are a lot of great sites where you can find activities that will keep them occupied, without them getting overly excited. These activities are fun and most of all free.

Fun Activity Sites

Coloring Pages

Crafts

This is one of my favorite sites.

Tips

Don't forget, you need to also take care of yourself. Try to relax, I know easier said then done, but remember , you aren't in this boat alone. There are a lot of parents out here, helping you row this thing. Sometimes you need to sit back and let others row a bit, while you relax a few minutes.

Take at the very least an hour, just for yourself. Crazy thought I know, but try it and see how that feels. Listen to some music, read a book, watch your favorite show. Do something that will keep your mind occupied for even an hour. If you are thinking to yourself, "am I doing enough for my child, could I be doing more?" Trust me you probably are doing everything you can. Remember to talk to people who know what you are going through, someone that can relate to what you are dealing with. If you can't find anyone in your family, or anyone in your area, please remember you can alwaysEmail Meand I know what you are going through, so do not hesitate to drop me a line.