Thyrotoxic crisis as an acute clinical presentation in a child

Abstract

A previously well, 4-year-old girl presented with a 4-6 weeks' history of increased appetite, weight loss, tiredness, sleep difficulty, excessive sweating, swelling in the neck and new-onset 'prominent, protruding eyes.' Family history revealed paternal grandmother receiving treatment for hyperthyroidism. Clinical assessment demonstrated features of thyrotoxicosis (tachycardia, warm peripheries, small smooth goitre with no nodules, exophthalmos). TFT (Free T4=101 pmol/L, thyroid-stimulating hormone <0.05 mIU/L) with raised thyroid peroxidase antibody levels (TPO=541 IU/mL) confirmed autoimmune hyperthyroidism. Observation on the ward showed features of thyrotoxic crisis with persistent severe tachycardia on ECG (sinus tachycardia with left ventricular hypertrophy (LVH)) and hypertension. Ultrasound thyroid showed diffuse thyroiditis with no focal lesion. Echocardiogram confirmed the above findings. A diagnosis of Graves' disease with thyrotoxic crisis was made. Antithyroid treatment (carbimazole) and beta-blocker (propranolol) was commenced. Thyrotoxic crisis resolved over 2 weeks and the child has continued to respond to carbimazole treatment at 1-year follow-up.

Recurrent impending thyroid storm in a girl with Graves’ disease: a case report

“…There is usually a thyroid storm precipitator, such as infection, surgery, trauma, non-compliance to antithyroid medication, abrupt cessation of antithyroid medication, or radioactive iodine ablation. 3,7,8 In this case, there was no known precipitating event in the first thyroid storm episode, but the second episode was precipitated by HAP.…”

Thyrotoxicosis and Impending Thyroid Storm: A Rare Paraneoplastic Syndrome in an Infant With Hepatoblastoma

“…Thyroid storm is a rare, life-threatening condition in children with thyrotoxicosis. The incidence of TS in children is unclear, and few cases have been reported in the pediatric population to date [ 2 ]. Between 2003 and 2014, the incidence of TS in adults ranged from 0.57 to 0.76 cases per 100 000 persons per year in the United States [ 5 ].…”

“…During an episode of thyrotoxicosis, increased thyroid hormone levels lead to a hypermetabolic state, which causes increased cardiac output, including tachycardia and hypertension [ 6 ]. Known precipitating factors of TS include stress from surgical interventions, trauma, infection, and acute iodine load [ 2 ].…”

“…In children, TS is an infrequent phenomenon with no documented incidence rate in the United States. Precipitating factors include cessation of antithyroid medication, surgical or trauma-related stress, or radioactive iodine therapy in a patient with underlying or poorly controlled GD [ 2 ]. Thyroid storm may lead to multisystem organ failure with manifestations of vomiting, diarrhea, tachycardia, fever, hepatic dysfunction, hypotension, and congestive heart failure [ 2 ].…”

Thyroid Storm in a Toddler Presenting as a Febrile Seizure

“…The incidence of thyroid storm in cases of pediatric hyperthyroidism is not known but is likely rare with only single cases or small case series reported in the literature, mostly in school-aged to teen-aged children. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] Infection, surgery, diabetic ketoacidosis, or nonadherence to antithyroid medications can trigger thyroid storm, but an obvious precipitant is not always evident, 11,17,25 as in our case. Initial presentation can include life-threatening congestive heart failure and arrhythmias as well as central nervous system disturbances including agitation, lethargy, and seizures.…”