{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:15:47Z","timestamp":1791605747985,"version":"4.3.4"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T00:00:00Z","timestamp":1619654400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Previous studies have identified frequent comorbid neuropsychiatric disorders and conditions in adults with thyrotoxicosis. These studies are scarce or even lacking in pediatric population. This work aimed to study the behavior of children and adolescents with Graves\u2019 disease (GD). This study included 35 children with GD (boys = 15; girls = 25; mean age: 11.45\u00b11.50yrs) and 40 healthy children (boys = 20; girls = 20; mean age: 12.54\u00b11.62yrs). Behavior was assessed using Child Behavior Checklist (CBCL). Children with GD were assessed during periods of thyroid hormone elevation (active disease) and normalized thyroid hormones (with anti-thyroid drugs or ATDs). Compared to healthy children, patients during periods of thyroid hormone elevation (74.29%) and normalized thyroid hormones (31.43%) had higher frequencies of behavioral abnormalities and scorings of total CBCL scale (P = 0.01; P = 0.04, respectively) and its subscales\u2019 [Anxious\/Depressed (P = 0.02; P = 0.04), Withdrawn\/Depressed (P = 0.03; P = 0.04) and Somatic Complaints (P = 0.03; P = 0.127) and Social (P = 0.01; P = 0.225), Thought (P = 0.01; P = 0.128) and Attention (P = 0.01; P = 0.01) problems], indicating internalizing and externalizing problems. The majority of patients had at least two different behavioral problems. Marked improvement was found during period of normalized thyroid hormones (P = 0.001). Correlation analyses showed significant associations between total CBCL scoring and age at onset (P = 0.01; P = 0.001) and lower concentrations of thyroid stimulating hormone (TSH) (P = 0.001; P = 0.04) and higher concentrations of free thyroxine (fT4) (P = 0.01; P = 0.02), triiodothyronine (fT3) (P = 0.01; P = 0.03) and thyrotropin receptor antibodies (TRAbs) (P = 0.001; P = 0.01) during periods of thyroid hormone elevation and normalized thyroid hormones, respectively. Multiple linear regression analysis showed that \"at presentation\" lower concentrations of TSH (P = 0.001; P = 0.03) and higher concentrations of fT4 (P = 0.001, P = 0.01), fT3 (P = 0.01; P = 0.06) and TRAbs (P = 0.001; P = 0.001) were predictors of behavioral problems during periods of active disease and normalized thyroid hormones. We conclude that GD is associated with higher frequencies and severities of anxiety, depression and inattention during periods of thyroid hormone elevation as well as normalized thyroid hormones with ATDs. Therefore, early diagnosis and optimizing management are required to improve children\u2019s social life.<\/jats:p>","DOI":"10.1371\/journal.pone.0248937","type":"journal-article","created":{"date-parts":[[2021,4,29]],"date-time":"2021-04-29T13:37:38Z","timestamp":1619703458000},"page":"e0248937","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Behavioral assessment of children and adolescents with Graves\u2019 disease: A prospective study"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1441-3530","authenticated-orcid":true,"given":"Sherifa Ahmed","family":"Hamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fadia Ahmed","family":"Attiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir Kamal","family":"Abdulhamid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Fawzy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,29]]},"reference":[{"issue":"1","key":"pone.0248937.ref001","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/S0889-8529(05)70302-9","article-title":"Thyrotoxicosis in children","volume":"27","author":"D Zimmerman","year":"1998","journal-title":"Endocrinol Metab Clin North Am"},{"issue":"6","key":"pone.0248937.ref002","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1530\/eje.0.1300565","article-title":"Incidence of juvenile thyrotoxicosis in Denmark, 1982\u20131988 A nationwide study","volume":"130","author":"L Lavard","year":"1994","journal-title":"Eur J Endocrinol"},{"issue":"6","key":"pone.0248937.ref003","first-page":"565","article-title":"Evidence for a major role of heredity in Graves\u2019 disease: a population-based study of two Danish twin cohorts","volume":"130","author":"TH Brix","year":"1994","journal-title":"J Clin Endocrinol Metab"},{"issue":"2","key":"pone.0248937.ref004","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1176\/jnp.8.2.181","article-title":"A survey study of neuropsychiaric complaints in patients with Graves\u2019 disease","volume":"8","author":"RA Stern","year":"1996","journal-title":"J Neuropsychiatry Clin Neurosci."},{"issue":"10","key":"pone.0248937.ref005","first-page":"578","article-title":"Chronic distress syndrome in patients with Graves\u2019 disease","volume":"99","author":"C Scheffer","year":"2004","journal-title":"Med. 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