Pediatric Graves Disease Differential Diagnoses

Updated: Feb 11, 2022
  • Author: Sunil Kumar Sinha, MD; Chief Editor: Sasigarn A Bowden, MD, FAAP  more...
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Diagnostic Considerations

Graves disease can be masked by the presence of concurrent illness, such as diabetic ketoacidosis. Neonates with Graves disease as a result of transplacental passage of maternal antibodies may be missed unless the maternal history is carefully assessed and the diagnosis is considered. Graves disease may be confused with ADHD, leading to delays in treatment.

Children with pituitary resistance to thyroid hormone, a rare genetic disorder, have been diagnosed mistakenly with hyperthyroidism and treated with antithyroid drug therapy or thyroid ablative therapy. The diagnosis is predicated on the finding of elevated thyroid hormone levels, elevated or reference range TSH levels, and no evidence of pituitary disease. Diagnosis can be confirmed by identification of family history and of a mutation in the thyroid hormone receptor gene.

Conditions to consider in the differential diagnosis of Graves disease include the following [12] :

  • TSH-secreting pituitary tumor

  • Autonomously functioning thyroid nodule

  • Toxic multinodular goiter

  • Ingestion of exogenous thyroid hormone

  • Hydatidiform mole/choriocarcinoma

  • Struma ovarii associated with a teratoma

  • Pituitary resistance to thyroid hormone

  • Subacute thyroiditis

  • Metastatic follicular carcinoma

  • Bipolar disorder

  • Drug induced (eg, amiodarone, iodine-containing compounds)

Differential Diagnoses