IMPE Abstracts

Thyroid storm (TS) is the most extreme manifestation of thyrotoxicosis and is considered an endocrine emergency. In pediatrics there are only isolated case reports. We present the description of a pediatric case of TS. A 19-year-old female adolescent was evaluated for the 1° time in pediatric endocrinology unit in 2013, at the age of 10 years, for growth and development. On physical examination, goiter GII was detected. Detailed clinical history showed symptoms of anxiety, palpitations with exercise, weight loss, sweating and heat intolerance. Tests were compatible with primary hyperthyroidism TSH <0.005 IU/ml (NR 0.7-5.7), FT4 2.01 ng/dl (NR 0.8-2), T4 13.2 mg/dL (NR 5.5-11.7), TRAbs 1.6 IU/L (NR< 1.5), Anti-TPO antibodies 995 IU/ml (NR < 5.61). Thyroid ultrasound (TU) found diffuse hypervascular goiter. Treatment with thiamazole 0.45 mg/kg/day was iniciated, evolving with normalization of thyroid function tests. In July 2014 treatment was discontinued, evolving 4 months later with suppressed TSH and increasing TRAbs (2.8IU/L). TU showed a finely irregular thyroid gland, heterogeneous parenchyma without nodules; thyroid scintigraph showed diffuse increased uptake. Thiamazole 0.12 mg/kg/day was restarted with good response, maintaining doses between 0.08-0.36 mg/kg/day for 5 years (2014-2019) without adverse effects. In March 2020, (17 years old), she restarted symptoms of hyperthyroidism, the dose of thiamazole was increased to 0.56 mg/kg/day and propranolol was added. After stabilization, it was decided to manage with Radioiodine (RI) 20 mCi in October 2020, prepared with prednisone 20 mg/day and propanolol. Ten days later she started with hyperemesis, dehydration, tachycardia, mild compromise of consciousness, elevated thyroid hormones and altered liver function tests. TS was diagnosed and managed in the ICU with IV hydration, hydrocortisone (50 mg every 8 hours), thiamazole up to 20 mg every 8 hours (1 mg/kg/day), propanolol up to 60 mg every 8 hours and cholestyramine 2g every 8 hours. She responded adequately to therapy, with a decrease in heart rate and stabilization of thyroid tests, finally achieving suspension of propanolol and reduction of thiamazole dose. Currently, she is treated with thiamazole 5 mg/day, her last thyroid function tests were done in August 2022: TSH 7.48 IU/ml (NR 0.7-5.7), T4L 1.25 ng/dL (NR 0.8-2.0). TS after RI treatment is an infrequent complication in pediatrics, an endocrine emergency that requires high suspicion, early treatment and multidisciplinary approach in ICU for a favorable outcome.