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Journal of Pediatric Endocrinology and Metabolism

Editor-in-Chief: Kiess, Wieland

Editorial Board Member: Darendeliler, Feyza / Gustafsson, Jan / Luo, Feihong / Mericq, Veronica / Lanes M. D., Roberto / Battelino, Tadej / Buyukgebiz, Atilla / Cassorla, Fernando / Chrousos, George P. / Cutfield, Wayne / Fideleff, Hugo L. / Hershkovitz, Eli / LaFranchi, Stephen H. / Mohn, Angelika / Root, Allen W. / Rosenfeld, Ron G. / Wabitsch, Martin / Werther, George / Zadik, Zvi

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Encephalopathy and sinustachycardia in childhood a possible differential diagnosis

1 / Jörg Brand2 / Stefan Vlaho2

1Intensive Care Unit, Children’s Hospital, Goethe University, Frankfurt (Main), Germany

2Center of Pediatrics, University Clinic of Frankfurt, Frankfurt (Main), Germany

Corresponding author: Tobias Hecht, Intensive Care Unit, Children’s Hospital, Goethe University, Theodor Stern Kai 7, Frankfurt (Main) 60590, Germany

Citation Information: Journal of Pediatric Endocrinology and Metabolism. Volume 25, Issue 1-2, Pages 149–151, ISSN (Online) 2191-0251, ISSN (Print) 0334-018X, DOI: 10.1515/jpem-2011-0436, January 2012

Publication History:
Received:
2011-10-20
Accepted:
2011-12-10
Published Online:
2012-01-17

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.

Keywords: drug-resistant thyroid storm; encephalopathy; Graves’ disease; seizure; thyroidectomy

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