Pediatric Thyroid-Associated Orbitopathy: Clinical Spectrum, Systemic Implications, and Outcomes Over a 26-Year Single-Center Experience

Abstract Background : Thyroid-associated orbitopathy (TAO) is an uncommon extrathyroidal manifestation of Graves’ disease in children and adolescents. Compared with adults, pediatric TAO usually presents with a milder clinical course, although its systemic and psychosocial impact may be underestimated. Methods : A retrospective case series was conducted including patients younger than 18 years diagnosed with TAO between 1999 and 2025 at a tertiary ophthalmology referral center in Mexico. Demographic characteristics, clinical manifestations, diagnostic studies, treatment modalities, and outcomes were analyzed. A narrative review of the literature was also performed. Results : Seventeen patients were included (70.6% female), with a mean age at diagnosis of 12 years. The most frequent clinical manifestations were eyelid retraction (100%) and proptosis (88.2%). No cases of dysthyroid optic neuropathy or irreversible visual loss were identified. Most patients were successfully managed with conservative medical treatment and endocrinologic control. Orbital decompression surgery was required in two patients (11.7%). Clinical outcomes were favorable in all cases. Conclusions : Pediatric TAO is an infrequent condition with a generally mild ocular course. Conservative management is effective in most patients, reserving surgery for selected cases. Pediatric TAO should be regarded as part of a systemic autoimmune disorder with ocular, behavioral, and psychosocial implications distinct from adult disease.