All children and adolescents with
Graves' disease in the county of Uppsala (catchment area population 250,000) treated between 1970 and 1994 were evaluated in a retrospective study. The material comprised 31 patients with a mean age of 11 years (range 4-16), 29 (94%) of whom were girls, and four (13%) of the patients had
Down's syndrome. Treatment was primarily conservative and surgery was considered if prolonged medical treatment failed. Lasting remission after
antithyroid drug therapy (median 6.5 years; range 4.5-8 years) was noted in 6/31 patients (19%), three (10%) of whom subsequently developed
hypothyroidism. Twenty-four of the remaining patients (77%) ultimately underwent subtotal (N = 20) or total
thyroidectomy (N = 4) after experiencing one or more episodes of recurrent
hyperthyroidism during medical treatment (median 6 years; range 0.5-11 years). After surgery one patient developed permanent
hypocalcemia requiring low-dose
vitamin D supplementation. During a postoperative follow-up period of 12.2 years ( median; range 1-17 years), there were two cases of recurrent
thyrotoxicosis, 1 and 10 years after surgery. The results underline that gender and
Down's syndrome are risk factors of juvenile
Graves' disease and that the disorder often is difficult to control by long-term medical
therapy. In such cases thyroid surgery offers a safe and prompt reversal of the
thyrotoxicosis. A proportion of the patients may ultimately develop
hypothyroidism, substantiating a need for long-term follow-up of persons afflicted with
Graves' disease early in life.