Encephalopathy and sinustachycardia in childhood--a possible differential diagnosis

Journal of Pediatric Endocrinology & Metabolism : JPEM
Tobias HechtStefan Vlaho

Abstract

We report on a 7-year-old girl with generalized seizures, somnolence, fever, and respiratory distress. The increase of sinus tachycardia with good hydration, sufficient analgesia, and hyperthermia in our patient led to the determination of thyroid hormones, and therefore finally to the diagnosis of a thyrotoxic crisis in Graves' disease. Thyrotoxic crisis is a very rare but severe disease with an incidence of 0.1/100,000-3/100,000 among children. Important differential diagnoses of hyperthyroidism are Hashimoto thyroiditis, paraneoplastic thyroid-stimulating hormone production, thyroid autonomy, as well as central hyperthyroidism. Although symptoms disappear by thyrostatic therapy (thiamazole, carbimazole, dexamethasone), a euthyroid status could only be achieved by thyroidectomy. Thyrotoxic crisis should be considered a differential diagnosis in case of resistant unexplained sinus tachycardia, seizures, and encephalopathy. Immediate and adequate therapy contributes significantly to a reduction in the high morbidity and mortality rates. A combination of several treatment approaches for hyperthyroidism can lead to a successful outcome.

Citations

Aug 26, 2014·Journal of Pediatric Endocrinology & Metabolism : JPEM·Aslıhan AbbasoğluAylin Tarcan
May 2, 2017·Clinical Pediatric Endocrinology : Case Reports and Clinical Investigations : Official Journal of the Japanese Society for Pediatric Endocrinology·UNKNOWN Committee on Pharmaceutical Affairs, Japanese Society for Pediatric Endocrinology, and the Pediatric Thyroid Disease CommittOsamu Arisaka
Aug 18, 2020·Respiratory Medicine Case Reports·Taiki HigakiAtsunori Nakao
Jun 24, 2021·Journal of Pediatric Endocrinology & Metabolism : JPEM·Masao NogamiShuji Sai

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