Graves/Basedow disease

Graves is a form of hyperthyroidism, which means there is too much thyroid hormone in the blood. Hyperthyroidism is rare in children and adolescents.

This form of hyperthyroidism is an autoimmune disease. The immune system produces antibodies that attack the thyroid gland. These antibodies act like thyroid stimulating hormone (TSH) and cause the gland to make too much thyroid hormone.

During a physical examination, the doctor sometimes finds:

• Weight loss (= most frequent symptom)
• Fatigue and irritability
• Growth acceleration
• Rapid pulse and high blood pressure
• Fine tremors in the hands
• Rapid tendon reflexes
• Swollen thyroid gland
• Bulging or protruding eyeballs (exophthalmia)

A blood analysis shows that thyroid hormone (T4) levels are too high and thyroid stimulating hormone (TSH) levels are very low. Anti TSH receptor antibodies (TRAb) are present. 

Additionally, an ultrasound of the thyroid gland can be performed to detect this disease. 

The signs and symptoms of too much thyroid hormone vary greatly, including: 

• Always feeling too hot and sweating a lot
• Nervousness, difficulty concentrating, sleeping poorly
• Rapid pulse, possibly with cardiac arrhythmias
• Weight loss despite eating a lot
• Abdominal cramps and diarrhoea
• Menstrual disorders

Graves’ disease can be treated with drugs, radioiodine administration or surgery. Because the disease sometimes resolves spontaneously, drugs are used first, such as thiamazole (brand name Strumazol® or Thyrozol®).  If the heart rate accelerates or heart rhythm disturbances occur, a beta-blocker is also given temporarily to slow the heart rate back down to normal. 

By administering thiamazole, thyroid hormone production will generally almost completely stop and extra thyroid hormone may be given to bring the amount ​​in the blood back to normal, or the thiamazole dose may be reduced. 

After at least two years of treatment, treatment can be discontinued on a trial basis if the TSH receptor antibodies have disappeared. That chance of sustained remission is quite high at 30 to 50%. If the disease flairs up again, thiamazole is then restarted. In older children, destruction of the thyroid gland can be discussed as an alternative to another treatment cycle of thiamazole. This results in a lifelong need for thyroxine replacement therapy. Thyroid gland destruction can be performed by administering radioactive iodine or by surgical removal of the entire thyroid gland.