Fracture in a girl with graves’ disease induced by osteoporosis: A case report

A 6-year-old girl with long-standing Graves' Disease (GD) presented with a left oblique non-displaced humeral fracture. Examination reveals signs of thyrotoxicosis and mild swelling of her left humerus. Investigations confirmed severe overt hyperthyroidism due to GD. A dual-energy X-ray Absorptiometry (DXA) of the lumbar vertebrae (L1-4) and femoral neck revealed that Z-score were -2.9 and -2.1, respectively, representing below the expected range for age which is consistent with osteoporosis. The girl was commenced on carbimazole in a dose of 5 mg two times daily and propranolol 10 mg two times daily. After one year of treatment, she returned to a euthyroid state, and Bone Mineral Density (BMD) increase by 19% and 23% of the lumbar spine and femur neck, respectively