|
1
|
Azova S, Rajabi F, Modi BP, Mansfield L, Jonas MM, Drobysheva A, Boyd TK, Wassner AJ, Smith JR. Graves' disease in a five-month-old boy with an unusual treatment course. J Pediatr Endocrinol Metab 2021; 34:401-406. [PMID: 33675208 PMCID: PMC10653980 DOI: 10.1515/jpem-2020-0549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Graves' disease (GD) is rare in children under age five years. Antithyroid drugs are typically first-line therapy but carry the risks of agranulocytosis and liver dysfunction. CASE PRESENTATION A male infant with multiple congenital anomalies, left ventricular hypertrophy, and neurologic dysfunction developed GD at five months of life. The presence of chronic hepatitis complicated medical management. Potassium iodide was effective temporarily, but urgent thyroidectomy was required at nine months of age. Postoperatively, the patient developed a thyroid function pattern consistent with impaired pituitary sensitivity to thyroid hormone (TH) that responded to the addition of liothyronine. Exome sequencing revealed a heterozygous de novo duplication of the ATAD3 gene cluster, suggesting a possible mitochondrial disorder. CONCLUSIONS This case describes the youngest child to date to be diagnosed with endogenous GD and to successfully undergo definitive treatment with thyroidectomy. An underlying defect in mitochondrial function is suspected, suggesting a potential novel pathophysiologic link to early-onset thyroid autoimmunity. Additionally, this case illustrated the development of impaired pituitary sensitivity to TH following thyrotoxicosis of postnatal onset, which may contribute to our understanding of hypothalamic-pituitary-thyroid (HPT) axis development.
Collapse
Affiliation(s)
- Svetlana Azova
- Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Farrah Rajabi
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA, USA; and Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Biren P. Modi
- Department of Surgery, Boston Children’s Hospital, Boston, MA, USA; and Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
| | - Laura Mansfield
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; and Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA
| | - Maureen M. Jonas
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA; and Division of Gastroenterology, Hepatology and Nutrition, Boston Children’s Hospital, Boston, MA, USA
| | - Anastasia Drobysheva
- Department of Pathology, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Theonia K. Boyd
- Department of Pathology, Texas Children’s Hospital, Houston, TX, USA
| | - Ari J. Wassner
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; and Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
| | - Jessica R. Smith
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA; and Thyroid Center, Boston Children’s Hospital, Boston, MA, USA
| |
Collapse
|