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

Abstract

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.

A Case of Thyroid Storm Associated with Cardiomyopathy and Poststreptococcal Glomerulonephritis

“…Aslan et al described a case of an 11-year-old patient who presented with a similar condition to our patient with fever, tachycardia, and hypertension in the setting of a viral illness [1]. This patient was diagnosed using the Burch-Wartofsky criteria with a score of 60.…”

“…Hyperthyroidism occurs with an incidence of 1 per 100,000 children, mostly commonly in postpubertal females [1]. Prepubertal patients represent a diagnostic challenge with more atypical signs and symptoms at presentation which may lead to a delay in diagnosis.…”

A Rapidly Fatal Case of Lactobacillus Rhamnosus Sepsis Associated with Thyroid Storm in an Immunocompetent Patient

“…The patient's symptoms of fever, tachycardia, and vascular disease along with his abnormal thyroid function tests are also commonly seen in thyroid storm, which further confounded the diagnosis. Using the clinical decision rules suggested by Burch and Wartofsky, the patient would have scored 50 points (20 for tachycardia at 138 bpm, 20 for temperature at 39.3°C and 10 for precipitating event of L. rhamnosus sepsis), which is suggestive of thyroid storm (> 45 points) [3]. Thyroid storm is an extreme form of hyperthyroidism with a more severe presentation that is associated with a high mortality rate.…”

“…The overall incidence of hyperthyroidism is estimated to be around 1%, with the majority of cases being subclinical in terms of presentation [2]. Among hospitalized hyperthyroid patients, the incidence of thyroid storm has been noted to be <10% [2,3]. However, the mortality rate of thyroid storm without treatment is about 90%, which drops to about 30% with treatment [2].…”

“…However, the mortality rate of thyroid storm without treatment is about 90%, which drops to about 30% with treatment [2]. Patients may suffer from congestive heart failure, sepsis, or respiratory failure ultimately leading to death due to multiple organ failure (MOF) [2][3][4][5].…”