A Case of Thyroid Storm Associated with Cardiomyopathy and Poststreptococcal Glomerulonephritis

Abstract

Thyroid storm has a high mortality rate and is often associated with a precipitating factor such as intercurrent illness or infection. It is rare in pediatric patients. Cardiac disease in hyperthyroidism mostly manifests itself as tachycardia but more serious cardiac findings have also been described. A 5-year-old male with recent strep throat infection presented with dilated cardiomyopathy, hematuria, and symptoms and lab findings consistent with severe hyperthyroidism. He was diagnosed with thyroid storm secondary to concurrent Graves' disease and poststreptococcal glomerulonephritis (PSGN). After starting the treatment with methimazole and a beta-blocker, his cardiac disease gradually improved and the PSGN resolved over time. There are no specific pediatric criteria for thyroid storm. Adult criteria can be difficult to apply to pediatric cases. Criteria for diagnosis of thyroid storm are less clear for pediatric patients. Dilated cardiomyopathy is a rare cardiac manifestation of hyperthyroidism. PSGN is due to glomerular immune complexes and can complicate group A strep infection. Providers should be aware of cardiac disease as a complication of hyperthyroidism. PSGN should not mechanistically be related to hyperthyroidism but can precipitate the signs of thyroid storm such as hypertension. This association has not been previously reported in the literature.

Thyroid Storm-induced Severe Dilated Cardiomyopathy and Ventricular Tachycardia

“…Thyroid storm in the setting of GD often presents after a precipitating factor such as surgery, infection, non-compliance with anti-thyroid medication, or radioactive iodine ablation, with prior illness being the most common trigger [2]. Our patient reported non-adherence to her prescribed anti-thyroid medications due to financial hardship and inability to afford physician follow-up visits.…”

“…Burch-Wartofsky score is used to assess the probability of thyrotoxicosis based on clinical findings [2]. A score greater than 45 is highly suggestive of thyroid storm.…”

“…Elevated thyroid hormone levels are thought to mimic adrenergic excess state by directly upregulating cardiac β receptors and enhancing myocardial sensitivity to sympathetic and vagal innervation [2,4-5]. Thyroid hormone can also indirectly cause peripheral vasodilatation, decrease systemic vascular resistance, and increase in cardiac output by up to 300% [2]. Hence, beta-blockers are a vital component of thyroid storm management.…”

“…Hyperthyroidism is an uncommon cause of dilated cardiomyopathy (DCM) and heart failure. Burch-Wartofsky criteria are used in the diagnosis of thyroid storm [2]. If a patient develops cardiomyopathy without a known etiology, it is essential to assess the patient’s thyroid function, as early treatment of hyperthyroidism can reverse the left ventricular dysfunction [1].…”

Hypopituitarism: A Very Rare Cause of Dilated Cardiomyopathy in a Child

“…It can be either a primary condition or secondary to a host of secondary causes with the commonest recognizable cause being myocarditis 3 . Endocrinologic causes of DCMP are extremely rare in children; mostly associated with thyroid dysfunction 5 . Among the adults also, metabolic causes constituted only 1.5% of cases, again, mostly due to thyroid disorders 6 .…”