Intraoperative identification and management of thyroid storm in children

Morrison, Michele P.; Schroeder, Ashley A.

doi:10.1016/j.otohns.2006.06.1248

Cited by 7 publications

(5 citation statements)

References 4 publications

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“…Our case serves to outline the treatment options for TS in a pediatric patient, especially in those unable to tolerate first-line pharmacologic therapies such as methimazole or PTU. Only two case reports of perioperative pediatric TS have been published in the past 20 years [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with hyperthyroidism may require anesthetic care during surgical therapy to treat the primary disease process, for conditions that occur as a sequela of hyperthyroidism, or for unrelated conditions. Regardless of the surgical indication, when surgical intervention is required in this patient population, there is an increased risk for morbidity and mortality related to the hyperthyroid state and the potential for the development of thyroid storm (TS) [5][6][7][8]. As TS can ultimately lead to cardiovascular collapse and death, appropriate preoperative identification of the hyperthyroid state, preoperative management strategies, and perioperative protocols are recommended.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Care of a Child With Hyperthyroidism

Bonanno,

Grannell,

Maves

et al. 2024

J Med Cases

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In pediatric-aged patients, hyperthyroidism generally results from the autoimmune disorder, Graves' disease (GD). Excessive levels of thyroid hormones (triiodothyronine and thyroxine) result in irritability, emotional lability, nervousness, tremors, palpitations, tachycardia, and arrhythmias. The risk of morbidity and mortality is increased when surgical intervention is required in patients with hyperthyroidism due to the potential for the development of thyroid storm (TS). A 3-year, 1-month-old child with a past medical history of GD presented for total thyroidectomy when pharmacologic control with methimazole was not feasible due to intolerance following development of a serum sickness-like illness. Prior to surgery, his thyrotoxicosis symptoms worsened with fever, tachycardia, diaphoresis, and hypertension. He subsequently developed TS and was admitted to the pediatric intensive care unit where management included hydrocortisone, potassium iodide, and β-adrenergic blockade with esmolol and propranolol. Thyroid studies improved prior to surgery, and a total thyroidectomy was successfully completed. Corticosteroid therapy was slowly tapered as an outpatient, and he was discharged home on hospital day 9. Following discharge, his signs and symptoms of thyrotoxicosis resolved, and he was started on oral levothyroxine replacement therapy. The remainder of his postoperative and post-discharge course were unremarkable. Only two case reports of perioperative pediatric TS have been published in the past 20 years. Our case serves as an important reminder of the signs of TS in children and to outline the treatment options in a pediatric patient, especially in those unable to tolerate first-line pharmacologic therapies such as methimazole or propylthiouracil.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative Care of a Child With Hyperthyroidism

Bonanno,

Grannell,

Maves

et al. 2024

J Med Cases

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“…The results returned seven articles, of which, only two described cases of intraoperative thyroid storm in a child. In one case, a 5-year-old male, had an enlarged thyroid prior to surgery that was missed [ 7 ]. In the other case, a 15-year-old male underwent surgery following trauma, but after further questioning, he reported having previous signs of hyperthyroidism prior to the trauma [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Graves’ disease, although the most common cause of hyperthyroidism in adults and children, is very uncommon in pediatric patients with an incidence of about 1 in 10,000, and pediatric thyroid storm is very rare [ 6 ]. Swift recognition of thyroid storm and initiation of treatment must be made to prevent further decompensation and restore homeostasis [ 7 ]. The patient’s parent provided written informed consent for publication of this case report.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves’ disease: a case report

et al. 2022

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Background Thyroid storm is a life-threatening manifestation of thyrotoxicosis and presents with fever, diaphoresis, tachycardia, hypertension, and widened pulse pressure. Case presentation We present a case of intraoperative thyroid storm in a 12-year-old female undergoing posterior spinal fusion. Despite adequate depth of anesthesia and analgesia, the patient was persistently tachycardic and hypertensive. The surgical procedure was uneventful. A thyroid panel drawn immediately after surgery showed undetectable thyroid stimulating hormone (TSH) and high free thyroxine (T4) consistent with thyroid storm. Conclusions Intraoperative thyroid storm in a pediatric patient is extremely rare with nonspecific clinical symptoms. Low to undetectable TSH and elevated free T4 is diagnostic.

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“…The incidence of pediatric thyrotoxicosis is 0.1/100,000 in young children and 3/100,000 in adolescents [ 2 , 4 ]. The majority of cases of pediatric thyrotoxicosis is secondary to Graves' disease, and patients typically present with weight loss, palpitations, tremors, tachycardia, and hypertension [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl

Aslan

Baca

Charlton

et al. 2011

International Journal of Pediatric Endocrinology

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Graves' disease is less common in prepubertal than pubertal children, and initial presentation with thyroid storm is rare. We report an 11-year-old prepubertal Hispanic girl who presented with a one-day history of respiratory distress, fever, and dysphagia. She had exophthalmos, a diffuse bilateral goiter and was agitated, tachycardic, and hypertensive. Nasal swab was positive for respiratory syncytial virus (RSV). She was diagnosed with thyroid storm and admitted to the pediatric intensive care unit. While infection is a known precipitant of thyroid storm and RSV is a common pediatric infection, to the best of our knowledge, this is the first reported case of RSV infection apparently precipitating thyroid storm in a prepubertal child.

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Intraoperative identification and management of thyroid storm in children

Cited by 7 publications

References 4 publications

Perioperative Care of a Child With Hyperthyroidism

Perioperative Care of a Child With Hyperthyroidism

Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves’ disease: a case report

Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl

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