Grave's disease in 4 yr old-other possible autoimmune disorders?

[jen9803]

My daughter is 4.5 yrs old and has a complicated medical history, significant for 25 wk preemie, BPD, CMV infection, many many bacterial infections, upper airway obstruction (formerly trached), and has ongoing pulmonary and airway issues (most recently a pulmonary hemorrhage).  We have had a full immunology workup, and aside from her C4 being right at low normal and her IgG2 low normal, and low titers for tetanus and strep pneumo, no other findings (we have revaccinated with Prevnar and the lung infections continue).

She was recently diagnosed with Grave's disease and we have started treatment with Methimazole.  One of my concerns is the possibility of other autoimmune disorder(s) that she may have.  We are still investigating the ongoing pulmonary issues, but I am very concerned about missing something or the fact that we keep addressing symptoms but never the root cause.

Any insight is appreciated.

[Deanna L Aftab Guy, MD]

thanks for your patience, so with Grave's being confirmed with her antibodies sky high, they might want to also get an uptake study to see if the gland has increased uptake or not, this will tell if her hyperthyroidism is Graves or what we call Hashitoxicosis, both caused by antibodies but Hashitoxicosis tends to improve and may not need as aggressive treatment. The bulging eyes tell me more that this is Graves though and I bet you are in excellent endocrinology hands.She is premie, that alone sets her up for many things, her infections are no doubt due to some premature lungs and she has had so much happen to her.
So other autoimmune disorders include celiac disease, diabetes,pernicious anemia, parathyroid disease, JRA, lupus, adddison's etc. She does NOT need screened for all of these. Rather, if there is any suspicion they can address this.
Hope she is doing better on methimazole, takes a good 2 weeks to really kick in then improvement is seen, follow with your endo regularly for bloodwork as needed!

[jen9803]

Her TPO AB was out of sight (>500, upper limit of <10).  Her TSH is super suppressed and Total T3 elevated.  Other symptoms include the bulging eyes, tachycardia, hyperactivity, sweaty, inattention, among others.