Plummeting grades, weight change, trouble focusing, it might be easy to blame your teen's behavior on the changes in adolescence. Your family doctor might suspect attention deficit disorder. But Graves' disease, a condition where the thyroid works overtime, can easily be overlooked in kids and teens.

Alissa Espinal loved performing on stage, until she hit middle school.

"I gained so much weight and I was so self-conscious about it," Alissa told Ivanhoe.

Alissa's parents also noticed their daughter had a hard time staying on task.

"Even simple things, like my mom would tell me to go get her juice and she'd tell me a specific flavor and I'd walk to the fridge and I'd forget," Alissa told Ivanhoe.

While Alissa's symptoms mimicked attention deficit disorder, the teen was actually struggling with a swing in thyroid hormones. At first her body didn't produce enough, and then it began to churn out too much.

Andrew J. Bauer, MD, Director of the Thyroid Center at the Children's Hospital of Philadelphia, told Ivanhoe, "It's kind of a thyroid gland that's gone rogue."

Pediatric thyroid specialists diagnosed Alissa with Graves' disease, meaning her thyroid gland was in overdrive.

Check a child's thyroid by having them look up at the ceiling. An enlarged thyroid will be obvious just above the collarbone.

Patients can take medication to help block the hormone production. Other options include radioactive iodine or surgery.

N. Scott Adzick, MD, Surgeon-in-Chief at the Children's Hospital in Philadelphia told Ivanhoe, "There should be no recurrence risk of Graves' disease when you take the entire thyroid out."

Alissa had surgery to remove her thyroid gland. She says the "fog" she once had has lifted.

"My high school GPA was actually a 1.7, that's how bad I was doing in school," Alissa told Ivanhoe.

Now she's an "A" and "B" student in college, making her father very proud.

Doctors say elevated heart rate and skin that is moist to the touch are also symptoms of Graves' disease. While most think of Graves ' disease as an adult condition, one in 10,000 kids will be diagnosed or about 8,500 cases every year.

BACKGROUND: Graves' disease is an immune system disorder that affects the thyroid, causing an overproduction of thyroid hormone, or hyperthyroidism. An estimated three million Americans have the disorder. Because the symptoms of Graves' disease are often similar to those of other conditions, many may be misdiagnosed. Women are more likely to have Graves' disease than men, and people over the age of 50 with a history of hypertension and atherosclerosis have a higher risk of developing the disease. Graves' disease can be diagnosed by blood tests, imaging or an ultrasound. Treatment for Graves' disease includes radioactive iodine therapy, anti-thyroid medications, beta blockers and surgery. In some cases, Graves' disease can affect the eye, and a doctor may prescribe medications specifically for these symptoms. The prognosis of Graves' disease is good and can be cured in some cases with prompt diagnosis and treatment. Dr. Andrew Bauer, Director of the Thyroid Center Children's Hospital of Philadelphia, says "if you can see the thyroid (a butterfly or ‘H' shaped gland that is situated just above the collar bone in the middle of the lower neck) then it is enlarged. The general term for an enlarged thyroid gland is a ‘goiter.' If the gland is really big, you can see it in a ‘chin-neutral' position, even without looking up."

(Sources: http://www.mayoclinic.org/diseases-conditions/graves-disease/basics/causes/con-20025811, http://www.rightdiagnosis.com/g/graves_disease/stats.htm, http://www.rightdiagnosis.com/g/graves_disease/intro.htm )

SYMPTOMS: The symptoms of Graves' disease are often subtle and sometimes mistaken for other conditions. The disorder mostly affects the hormone system, but 30 percent of those with Graves' disease show signs of Graves' ophthalmopathy, which involves the muscles and tissues around the eyes. Occasionally Graves' disease can also affect the skin. Overall, some of the symptoms of Graves' disease include:

· Anxiety

· Tremor in the hands

· Rapid or irregular heartbeat

· Enlargement of the thyroid

· Weight loss

· Vision loss

· Frequent bowel movements

· Thick, red skin on the shins or tops of the feet

(Source: http://www.mayoclinic.org/diseases-conditions/graves-disease/basics/symptoms/con-20025811)

GRAVES' DISEASE AND TEENAGERS: In teenagers, Graves' disease may go overlooked. The symptoms may look the same as those for excessive caffeine use, stress or even attention deficit disorder. "Sometimes they go through weeks or months of trying to be evaluated before someone realizes it could be hyperthyroidism," Dr. Andrew Bauer told Ivanhoe. "Inability to focus, emotional outbursts and erratic behavior may also be symptoms of Graves' disease in children and teenagers." (Source: http://www.gdatf.org/about/about-graves-disease/children-graves/, Andrew Bauer, MD, Children's Hospital of Philadelphia, http://www.gdatf.org/about/about-graves-disease/children-graves/)

* For More Information, Contact:

Ashley Moore

Public Relations Specialist

The Department of Surgery,

The Children's Hospital of Philadelphia

267-426-6071

Moorea1@email.chop.edu