Thyroid storm in pediatrics: a systematic review

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.

Diagnostic criteria and scoring systems for thyroid storm: An evaluation of their utility – comparative review

“…[4] Laboratory-based criteria heavily rely on thyroid hormone levels, particularly extreme elevations exceeding several times the upper reference range, to confirm thyroid storm. [5] Clinical Judgment becomes paramount in some instances where experienced healthcare providers rely on the overall clinical presentation and severity of symptoms to diagnose thyroid storm, especially when specific criteria or scoring systems may not be directly applicable. [8] Inflammatory Markers, such as C-reactive protein (CRP) and interleukin-6 (IL-6), have emerged in recent research as potential contributors to the diagnostic landscape, as their elevation can be indicative of thyroid storm.…”

“…Identifying unique metabolic signatures holds promise for gaining insights into the condition and its diagnosis. [5] Advanced imaging modalities like positron emission tomography and magnetic resonance imaging are explored for visualizing thyroid gland activity and inflammation, complementing traditional diagnostic criteria. [4] AI and machine learning algorithms are developing to analyze complex datasets, including clinical symptoms, laboratory results, and imaging findings.…”

“…Accurate diagnosis ensures the reasonable allocation of these resources, preventing unnecessary utilization or delayed distribution to patients genuinely in need. [5] Ultimately, the impact reverberates through patient outcomes. Timely and appropriate treatment, anchored in an accurate diagnosis, becomes the catalyst for stabilizing the patient's condition, mitigating symptom severity, and substantially enhancing the prospects of a full recovery.…”

An observation study of the effect of “Internet + Nursing” on psychological status and quality of life of patients with thyroid eye disease

“…Due to the long course of the disease and its exceptionally sluggish recovery, there are still multiple issues post-discharge for patients; enhancing patient nursing guidance and interventions following discharge is equally imperative for augmenting treatment efficacy and prognosis. [5] "Internet + Nursing" refers to the medical institutions providing nursing services to discharged patients or special populations suffering from severe illnesses who cannot visit hospitals, through the construction of the Internet + platform, which is accomplished by leveraging Internet technologies, big data, and other information technologies, employing online applications and offline service delivery methods. [6] In recent years, the "Internet + Nursing" platform builds a bridge between patients and hospitals, providing new ideas and directions for the treatment of various diseases.…”

“…Due to the long course of the disease and its exceptionally sluggish recovery, there are still multiple issues post-discharge for patients; enhancing patient nursing guidance and interventions following discharge is equally imperative for augmenting treatment efficacy and prognosis. [5]…”