Thyroid Storm in a Toddler Presenting as a Febrile Seizure

Abstract

Although simple febrile seizures are relatively common and benign in toddlers, it is important to rule out any underlying critical disease that necessitates further intervention and treatment. Thyroid storm, the extreme manifestation of hyperthyroidism, is relatively rare and not often considered in the differential diagnosis of a febrile seizure despite its high mortality rate. Here, we report 1 of the youngest patients with thyroid storm, who initially presented with a febrile seizure. After reevaluation, the 2-year-9-month-old patient was discovered to have thyromegaly, which led to recognition that her persistent tachycardia and widened pulse pressure were likely signs of thyrotoxicosis. Laboratory results were consistent with primary hyperthyroidism due to Graves’ disease. Thyroid storm was then diagnosed on the basis of clinical features including gastrointestinal and central nervous system disturbances. Treatment with methimazole, propranolol, hydrocortisone, and Lugol’s iodine solution was used. This medication regimen was safe and effective with restoration of a euthyroid state after 2 months and no recurrence of seizures. Improved awareness of hyperthyroidism and thyroid storm can lead to prompt diagnosis and treatment of this endocrine emergency, thus reducing mortality and morbidity. Pediatricians should consider this diagnosis in children with febrile seizures and suggestive vital signs and physical examination findings.

Thyroid Storm in an Adolescent Girl Precipitated by Empyema Thoracis

“…It is a life-threatening condition, with a mortality rate of 8%–25%. 3 There is evidence that any acute illness, such as stroke, surgery, infection, or trauma, can precipitate a thyroid storm. 7 In a case reported by Yuan et al, 8 a thyroid storm was precipitated by organophosphorus poisoning.…”

“…In the same case, Burch-Wartofsky score was 70, which led them to also use β2 blocker and methimazole for acute management. 10 Recently, Ladd et al, 3 reported a case of thyroid storm in a two years and nine months old child who presented with febrile seizure, persistent tachycardia, and wide pulse pressure.…”

“… 2 Thyroid storm as an initial manifestation is rare, especially in children, among whom its diagnosis is usually very challenging. 3 Thyroid storm can manifest anytime in underlying hyperthyroidism. Though manifestations of thyrotoxicosis are typical, a high index of suspicion of possible thyroid storm should be kept regarding any patient who presents with systemic decompensation.…”

Hipertiroidismo en niños y adolescentes: experiencia en un hospital universitario en Colombia

“…En lo que respecta a las crisis tirotóxicas, no se incluyó un análisis de las causas que las desencadenan; aun así, se estableció que uno de los casos se presentó después de la terapia de ablación por yodo radiactivo y otro se desencadenó por un cuadro infeccioso en el contexto de una leucopenia como reacción adversa al metimazol. No hay datos disponibles sobre la incidencia de la tormenta tiroidea en pediatría, probablemente por ser poco frecuente, y los datos se limitan a reportes de casos o pequeñas series de casos (21). Aun así, llama la atención que entre los 54 pacientes estudiados, una paciente presentó tormenta tiroidea, a diferencia del estudio de Williamson,et al (15), en el que no hubo casos entre los 110 pacientes incluidos, y de las demás series de pacientes con hipertiroidismo, en cuyos resultados no se alude a esta manifestación (12,13,16,17,22).…”

Unusual Etiology of Hypercalcemia in an Adolescent With Acute Gastroenteritis

“…A thyroid storm or thyrotoxic crisis occurs due to the sudden release of the thyroid hormones T4 and T3 into the circulation and results in acute worsening of the hyperthyroid state [ 7 ]. Clinical features of thyroid storm include tachycardia, fever, agitation, dehydration, shock, congestive failure, and if not treated, death [ 7 , 8 ]. Our patient presented with tachycardia and dehydration but no fever, shock, or congestive failure, and was therefore not in thyroid storm on presentation.…”