Thyroid storm with encephalopathy and cardiovascular symptoms refractory to medical management in an adolescent

Jigar C Chauhan; Meg Frizzola; Kimberly McMahon; Sarah Perry; James H Hertzog

doi:10.4103/IJCIIS.IJCIIS_58_19

Thyroid storm with encephalopathy and cardiovascular symptoms refractory to medical management in an adolescent

Int J Crit Illn Inj Sci. 2020 Jan-Mar;10(1):38-41. doi: 10.4103/IJCIIS.IJCIIS_58_19. Epub 2020 Mar 6.

Authors

Jigar C Chauhan^{1

2}, Meg Frizzola^{1

2}, Kimberly McMahon^{1

2}, Sarah Perry^{1

2}, James H Hertzog^{1

2}

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.
² Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.

Abstract

Thyroid storm (TS) is rare in pediatrics, most cases reported in literature responded well to medical therapy. We report the case of an adolescent female presented with TS refractory to anti-thyroid medical management. She had refractory hypertension, tachycardia, and progressive encephalopathy despite aggressive medical management. She underwent subtotal thyroidectomy after 2 weeks of failed medical management with a complete resolution of symptoms within days of surgery. We also learned sodium nitroprusside with its direct vasodilatory effect on conduit vessels, verapamil with its rate control properties, and labetalol with its dual sympathetic blockage property were beneficial in the management of this patient.

Keywords: Encephalopathy; hypertension; pediatric; thyroid storm.

Publication types

Case Reports