Objectives
Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves’ disease.
Case presentation
They were previously healthy adolescents without family history of thyroid disease. CNS symptoms varied from agitation to coma. GI symptoms included abdominal pain, vomiting, and diarrhea. Their laboratory studies revealed thyrotoxicosis and positive result of thyroid-stimulating antibody (TSAb). They were admitted to the intensive care unit (ICU) and received the combination of an antithyroid drug, Lugol’s solution, a beta antagonist, and hydrocortisone. The most severe case was a 13 year-old Japanese girl who presented with loss of consciousness and hemodynamic shock. She died after 5 days of intensive treatment.
Conclusions
Pediatricians should consider TS in the differential diagnosis when a patient exhibits both CNS and GI symptoms.
Surfactant protein C gene (SFTPC) variations may cause hereditary
interstitial lung disease (HILD), a disease with variable prognosis. The
evaluation of treatment responsiveness of HILD with SFTPC variation
remains unclear. We present the case of a child with HILD whose
respiratory condition was appropriately evaluated using a high-flow
nasal cannula (HFNC). A 12-month-old boy with SFTPC variation developed
progressive respiratory failure. Although he was once considered a
candidate for lung transplantation, his respiratory condition was
improved by hydroxychloroquine treatment, which prevented further
therapy. Compared to a conventional nasal cannula, which could not
deliver a stable oxygen concentration, HFNC allowed us to evaluate the
improvement of oxygenation more accurately.
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