Pediatric Graves' Disease: Clinical Features, Therapeutic Management and Outcomes in a Moroccan Cohort

Background: Graves’ disease is the most common cause of hyperthyroidism in children and adolescents. Despite its rarity in the pediatric population, it remains a significant clinical challenge because of its variable presentation, prolonged treatment course, and high relapse rates. Objective: To describe the epidemiological, clinical, biochemical, therapeutic, and outcome characteristics of children diagnosed with Graves’ disease in a tertiary pediatric endocrinology center. Methods: We conducted a retrospective descriptive study in the Pediatric Endocrinology Unit of the Children’s Hospital of Rabat, Morocco. Medical records of patients younger than 18 years diagnosed with Graves’ disease between January 2020 and December 2024 were reviewed. Demographic, clinical, biochemical, radiological, therapeutic, and follow-up data were retrospectively collected and analyzed using descriptive statistical methods. Results: Fifteen children were included. The mean age at diagnosis was 11.3 years (range: 3–17 years). Females predominated, accounting for 86.7% of cases (female-to-male ratio: 6.5:1). Down syndrome was identified in two patients (13.3%), whereas a family history of thyroid disease was reported in 40.0% of cases. Goiter was present in all patients. Tachycardia was observed in 86.7%, exophthalmos in 46.7%, weight loss in 33.3%, behavioral disturbances in 33.3%, tremor in 26.7%, diarrhea in 20%, hyperhidrosis in 13.3%, and asthenia in 13.3%. All patients exhibited biochemical hyperthyroidism with suppressed TSH levels and elevated thyroid hormone concentrations. Thyroid ultrasound revealed diffuse goiter in all patients, with hypervascularization in seven cases. All patients received carbimazole therapy. Beta-blockers were prescribed in six patients. Thyroidectomy was performed in three patients and radioiodine therapy in two patients. Clinical and biochemical euthyroidism was achieved in six patients (40%) after a mean duration of 4.2 months. Conclusion: Pediatric Graves' disease is a rare autoimmune disorder predominantly affecting adolescent girls and remains the leading cause of hyperthyroidism in childhood. Antithyroid drugs remain the cornerstone of treatment, although definitive therapies may be required in refractory cases.