**5. Differential diagnosis**

GD is the most common cause of thyrotoxicosis in children. However, it has to be clinically differentiated from other causes of thyrotoxicosis in childhood. These include hyperthyroid disorders, associated with increased secretion of the thyroid hormones from the thyroid gland, or cases of thyroiditis, where symptoms occur due to thyroid follicular disruption leading to release of preformed causes. Some of the common differential diagnostic causes have been summarized in **Tables 2**–**4**.

Consumption of biotin as a part of management of metabolic or dermatological diseases can lead to surreptitious laboratory results of elevated thyroid hormones, suppressed TSH and positive thyroid receptor autoantibodies with immunoassays utilizing the streptavidin-biotin platforms. Hence, laboratory results must be reconsidered and rechecked in the absence of supportive clinical features of thyrotoxicosis [31].


#### **Table 2.**

*Common associations of pediatric GD.*


#### **Table 3.**

*Differential diagnosis of GD: Hyperthyroid disorders.*


#### **Table 4.**

*Differential diagnosis of GD: Thyrotoxic disorders without hyperthyroidism.*
