513 A Clinicopathologic Study of Pediatric Graves Disease

Allen Choi; Frances Fan; Anand Rajan KD

doi:10.1016/j.labinv.2024.102743

Background Graves disease is an autoimmune disease caused by thyroid stimulating autoantibodies resulting in diffuse goiter, hyperthyroidism, infiltrative ophthalmopathy (exophthalmos), and infiltrative dermopathy (pretibial myxedema). It is the most common cause of hyperthyroidism in the pediatric population, with prepubertal patients exhibiting more severe symptoms. The histologic findings of Graves disease in the pediatric age group (<21 years of age) are not well-described in the literature. In this study, we seek to investigate the histopathologic features of pediatric Graves disease and compare to adult Graves disease, in correlation with the clinical and laboratory findings. Design We retrieved 38 thyroidectomy specimens for Graves disease <21 years between c.2000 and 2024. We included 20 most recent thyroidectomy specimens for adults with a diagnosis of Graves disease. All slides were reviewed and representative sections were selected for digital scanning with a 3D Histech P1000 instrument. 3DHistech software was used to annotate images for total area, areas of hyperplasia, width of fibrous septae, and number of lymphoid aggregates. We reviewed patient clinical data for 17 clinical parameters, duration of antithyroid therapy, and laboratory findings (such as TSH, T3, T4). Results Pediatric patients with Graves disease exhibited significantly more anxiety (p=0.049), and orbitopathy (p=0.07) (both χ2), exhibited greater incidence of anti-TPO antibodies (p=0.040, Mann-Whitney U), and lower levels of postsurgical TSH (p=0.016, student t-test). Among histopathologic parameters, residual hyperplasia was more prominent in adult thyroid but the results were not statistically significant. (p=0.05, student t-test). Median lymphoid aggregate counts were significantly higher in pediatric patients (p<0.005, k-means). No differences were identified in other clinical or laboratory parameters. Conclusions We report detailed histopathologic, clinical and laboratory findings in a large cohort of pediatric age Graves disease, spanning a 25-year period, with comparison to adult Graves disease. While we appreciated histopathologic differences between pediatric and adult Graves', they are subtle, and consist of greater treatment residual hyperplasia in adult Graves, and prominence of lymphoid aggregates in pediatric patients. Pathologists need to take these features into account when assessing disease severity at thyroidectomy in pediatric Graves disease.

513 A Clinicopathologic Study of Pediatric Graves Disease

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