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Aoki Y, Hanaki R, Toyoda H, Emori K, Miyahara M, Hirayama M. Case report: Thyroid storm in a three-year-old girl presenting with febrile status epilepticus and hypoglycemia. Front Pediatr 2023; 11:1213040. [PMID: 37397147 PMCID: PMC10311634 DOI: 10.3389/fped.2023.1213040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Thyroid storm, though extremely rare in toddlers, requires prompt diagnosis and treatment because it can be fatal if left untreated. However, thyroid storm is not often considered in the differential diagnosis of a febrile convulsion due to its rarity in children. Herein, we report the case of a 3-year-old girl with thyroid storm who presented with febrile status epilepticus. Although the seizure was stopped by diazepam administration, her tachycardia and widened pulse pressure persisted, and severe hypoglycemia was observed. Based on the findings of thyromegaly, a history of excessive sweating and hyperactivity, and a family history of Graves' disease, she was eventually diagnosed with a thyroid storm. The patient was successfully treated with thiamazole, landiolol, hydrocortisone, and potassium iodide. Propranolol, a non-selective β-blocker, has been used to manage tachycardia during thyroid storm. However, a cardio-selective β1-blockers, landiolol hydrochloride, was used in our case to avoid worsening hypoglycemia. Febrile status epilepticus is one of the most common medical emergencies in childhood; it is necessary to rule out treatable underlying critical diseases such as septic meningitis and encephalitis. Thyroid storm should be considered in children presenting with prolonged febrile convulsion accompanied by findings that are not usually observed with febrile convulsions.
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Affiliation(s)
- Yusuke Aoki
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ryo Hanaki
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Hidemi Toyoda
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
| | - Koichi Emori
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
- Department of Pediatrics, Okanami General Hospital, Iga, Japan
| | | | - Masahiro Hirayama
- Department of Pediatrics, Mie University Graduate School of Medicine, Tsu, Japan
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Abisad DA, Glenn Lecea EM, Ballesteros AM, Alarcon G, Diaz A, Pagan-Banchs P. Thyroid storm in pediatrics: a systematic review. J Pediatr Endocrinol Metab 2023; 36:225-233. [PMID: 36318760 DOI: 10.1515/jpem-2022-0309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Thyroid storm (TS) is an uncommon but severe manifestation of hyperthyroidism and an endocrine emergency, as it is fatal if it goes unrecognized. In pediatrics, the current literature is limited to case reports and case series. Current knowledge is extrapolated from adult data. This systematic review aims to present the epidemiology, most common etiologies, clinical presentation, and most accepted standard of care of TS in children. We aim to raise awareness of hyperthyroidism in the pediatric community. CONTENT The databases used were PubMed, google scholar, and LILACS, with the search terms "thyroid storm" AND "pediatrics". Studies included case reports and case series in English and Spanish from patients between the ages of 0-21 years with clinical features consistent with a diagnosis of TS based on ATA 2016, with or without reported scale scores, published between 2000 and 2022. Variables such as ethnicity, etiology, possible triggers, clinical features, and management components were analyzed and presented. SUMMARY We analyzed data from 45 patients. Their mean age was 11.25 years. The majority of them were from Asia (26%). The most common clinical features were sinus tachycardia (86.7%) and fever (64%), followed by altered mental status (46%) and diarrhea (31%). Graves' disease was the most common underlying condition, and infection the most common precipitant. Thirty one percent of patients received treatment with four components; however morbidity and mortality were not clinically significant with those who did not. TS has a heterogeneous presentation with multisystemic involvement. The most common symptoms in this review were fever, tachycardia, diarrhea, and altered mental status. OUTLOOK Further studies may be needed to best standardize the diagnosis and management of TS in children. Qualitative studies are needed to best assess the delay in diagnosis of hyperthyroidism and how this may impact prognosis in case patients were to develop TS.
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Affiliation(s)
| | | | | | - Guido Alarcon
- Pediatric Endocrinology, Baylor College of Medicine, Houston, TX, USA
| | - Alejandro Diaz
- Pediatric Endocrinology, Nicklaus Children's Hospital, Miami, FL, USA
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Lawrence CM, Seckold R, Nightingale S, Tumuluri K, King BR. Severe Graves' disease presenting with hepatic dysfunction in a 2-year-old child. J Paediatr Child Health 2022; 58:2106-2108. [PMID: 35757970 PMCID: PMC9796379 DOI: 10.1111/jpc.16088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/12/2022] [Accepted: 06/03/2022] [Indexed: 01/01/2023]
Affiliation(s)
- Christopher M Lawrence
- Department of Paediatric Diabetes & EndocrinologyJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia
| | - Rowen Seckold
- Department of Paediatric Diabetes & EndocrinologyJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia,Mothers and Babies Research InstituteHunter Medical Research InstituteNewcastleNew South WalesAustralia
| | - Scott Nightingale
- School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia,Mothers and Babies Research InstituteHunter Medical Research InstituteNewcastleNew South WalesAustralia,Department of Paediatric GastroenterologyJohn Hunter Children's HospitalNewcastleNew South WalesAustralia
| | - Krishna Tumuluri
- Department of OphthalmologyChildren's Hospital WestmeadSydneyNew South WalesAustralia,Sydney Medical School, Faculty of Medicine and HealthSave Sight Institute, The University of SydneySydneyNew South WalesAustralia
| | - Bruce R King
- Department of Paediatric Diabetes & EndocrinologyJohn Hunter Children's HospitalNewcastleNew South WalesAustralia,School of Medicine and Public HealthUniversity of NewcastleNewcastleNew South WalesAustralia,Mothers and Babies Research InstituteHunter Medical Research InstituteNewcastleNew South WalesAustralia
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García JS, Sarmiento MP, Bello JD, Zuluaga NA, Forero AC, Niño LF. Hyperthyroidism in children and adolescents: Experience in a university hospital in Colombia. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2022; 42:342-354. [PMID: 35867926 PMCID: PMC9443673 DOI: 10.7705/biomedica.6244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/29/2022] [Indexed: 11/21/2022]
Abstract
Introduction: Hyperthyroidism is a heterogeneous condition characterized by the excessive production of thyroid hormones. It represents a diagnostic and therapeutic challenge. Objective: To describe the clinical and paraclinical characteristics and the evolution and differences between the main etiologies in patients with hyperthyroidism treated by the Pediatric Endocrinology Service at the Hospital Universitario San Vicente Fundación in Medellín, Colombia, between July 1st., 2015, and June 30th., 2020. Materials and methods: We conducted a cross-sectional observational study with retrospective data collection. Results: We included 54 patients with a mean age of 11.9 years, 72.2% of whom were female; 85.2% had no history of comorbidities related to autoimmunity; 11.1% had a family history of Graves’ disease, and 29.6% of other thyroid diseases. Goiter was the most frequent clinical manifestation (83.3%) and 92.6% of the patients received treatment with methimazole, 79.6% required beta-blockers, and 11.2% additional drug therapy. Adverse drug reactions occurred in 16.7% of the patients and in 20.4% there was a resolution of hyperthyroidism (spontaneous: 9.3%; after radio-iodine ablation: 9.3%, and after surgery: 1.9%). Conclusion: Hyperthyroidism is a disease with diverse clinical manifestations. Its most frequent cause is Graves’ disease followed by hashitoxicosis, which in this study had a higher frequency than that reported in the literature. The duration and side effects of pharmacological treatment were similar to those previously reported, but the higher frequency of agranulocytosis is noteworthy.
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Affiliation(s)
- Judith Sofía García
- Programa de Endocrinología Pediátrica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - María Paula Sarmiento
- Programa de Endocrinología Pediátrica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Jesús David Bello
- Programa de Medicina, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - Nora Alejandra Zuluaga
- Programa de Endocrinología Pediátrica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Hospital San Vicente Fundación, Medellín, Colombia.
| | - Adriana Carolina Forero
- Programa de Endocrinología Pediátrica, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia; Hospital San Vicente Fundación, Medellín, Colombia..
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Mori T, Mitani-Konno M, Hagiwara Y, Hasegawa Y. Thyroid storm without precipitating factors in a previous healthy child: A case report. EMERGENCY CARE JOURNAL 2022. [DOI: 10.4081/ecj.2022.10165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Thyroid Storm (TS) is the severest form of thyrotoxicosis and is associated with a high mortality rate. TS presents with fever, tachycardia, gastrointestinal symptoms, and central nervous system dysfunction and may be overlooked if patients do not present thyrotoxic symptoms or have precipitating factors. We reported a pediatric case of TS with mild proptosis but no obvious precipitating factors in a previously healthy child. A 9-year-old, female patient with a history of attention-deficit hyperactivity disorder presented with the complaint of frequent vomiting. She was alert but lethargic with fever and tachycardia. Physical examination was unremarkable except for coolness in the extremities and a delayed capillary refill time of two seconds. Fluid resuscitation was ineffective in alleviating the tachycardia. Additional history-taking revealed a one-month history of mild proptosis but no other thyrotoxic findings or precipitating factors were found. Markedly elevated thyroxine and triiodothyronine and suppressed thyroid-stimulating hormone on thyroid function tests led to a diagnosis of TS. Methimazole, potassium iodine, bisoprolol, and hydrocortisone were administered. Her vital signs and thyroid functions gradually improved, and she was discharged 18 days after admission without any serious complications. She is currently euthyroid and clinically stable on 5 mg of methimazole at three months after admission. When tachycardia that is resistant to usual resuscitation is found, careful history-taking and physical examination targeting thyroid disorders should be performed to assess for TS.
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Nogami M, Constantine S, Sai S. Neurological and gastrointestinal symptoms as an initial presentation of pediatric thyroid storm: report of three cases. J Pediatr Endocrinol Metab 2021; 34:1197-1200. [PMID: 34162035 DOI: 10.1515/jpem-2021-0219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/12/2021] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Masao Nogami
- Department of Pediatrics, Teine Keijinkai Hospital, Sapporo, Japan
| | | | - Shuji Sai
- Department of Pediatrics, Teine Keijinkai Hospital, Sapporo, Japan
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Chrgondi M, Billa RD, Chacham S, Gurnurkar S. Unusual Etiology of Hypercalcemia in an Adolescent With Acute Gastroenteritis. Cureus 2021; 13:e16483. [PMID: 34430099 PMCID: PMC8372673 DOI: 10.7759/cureus.16483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/05/2022] Open
Abstract
We present the report of an adolescent female who presented with acute gastroenteritis, weight loss, and hypercalcemia. Further evaluation revealed hyperthyroidism to be the cause of hypercalcemia. Treatment of hyperthyroidism successfully corrected the hypercalcemia in our index case.
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Affiliation(s)
- Madhuradhar Chrgondi
- Pediatrics/Critical Care Medicine, Carver College of Medicine, University of Iowa, Iowa City, USA
| | | | - Swathi Chacham
- Pediatrics, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Shilpa Gurnurkar
- Pediatric Endocrinology, Nemours Children's Hospital, Orlando, USA
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