Graves' disease is a rare disorder in children, particularly in infants. Ocular manifestations of
Graves' disease in children are even more rare and are mild compared to adults. We report a 3-year-old girl with
Graves' ophthalmopathy who visited our clinic because of lacrimation. Her family had also noticed
exophthalmos,
goiter, irritability and increased appetite for more than 3 months. The ophthalmologist noted bilateral
proptosis, eyelid
erythema, lacrimation,
entropion of the lower eyelid, and superficial
keratitis. Her serum concentrations of free
thyroxine and free
triiodothyronine were high, and
thyroid-stimulating hormone (TSH) was low. Serum samples were markedly positive for
antibodies to
TSH receptor (TRAb) and
thyroid-stimulating antibody (TSAb). Although
hyperthyroidism was controlled with
propylthiouracil within 3 weeks, her eye signs did not improve. We administered
methylprednisolone pulse
therapy for ophthalmopathy, but the effect was limited and the lacrimation due to
entropion and superficial
keratitis persisted. Titers of both TRAb and TSAb decreased slightly and transiently with the pulse
therapy. One year later, both titers remained high and eye signs did not improve any more though she was clinically euthyroid. This might indicate that both TRAb and TSAb levels correlate with the
clinical course. Therefore, TRAb or TSAb might be good indicators of progress of
Graves' ophthalmopathy. Ocular manifestations of
Graves' disease should be followed closely with measurements of both TRAb and TSAb even in infant cases.