Thyroid storm in association with Grave's disease
Hi, my 11-year-old cousin with no significant past medical history presented with symptoms suggestive of hyperthyroidism (weight loss, heat intolerance). She has also experienced a decline in grades at school. Family history is significant for thyroid disease in both grandmothers (both on thyroid replacement therapies). The clinician ordered thyroid function tests including Free T4, T3, TSH, anti-TSH receptor antibodies, antithyroglobulin and anti-thyroid peroxidase antibodies. The laboratory findings confirmed the clinical impression and a diagnosis of Graves's disease (hyperthyroidism with thyrotoxicosis) was made. What is this Grave's disease and causes of thyroid storm? What are all the symptoms? Please help.
Graves' disease is the most common cause of thyrotoxicosis in children. The disorder is rare before the age of 3 and increases progressively with age thereafter. Hyperthyroidism accounts for 10- 15% of all pediatric thyroid disorders and children constitute 1-5% of all Graves' disease patients. In Graves' disease, autoantibodies stimulate the thyrotropin receptor and lead to excess thyroid hormone production.
Thyroid storm is a potentially fatal, though uncommon condition that affects 1% of individuals with thyrotoxicosis, and accounts for between 1 and 10% of patients hospitalized for thyrotoxicosis. It is an exaggerated state of thyrotoxicosis involving decompensation of one or more organ systems and carries a mortality rate of between 20 and 30%.
Besides thyroid surgery, thyroid storm is triggered by radioactive iodine therapy, uncontrolled diabetes, emotional stress, abrupt withdrawal of anti-thyroid medication, excessive palpation of the thyroid gland in hyperthyroid patients, thyroid hormone overdose, pulmonary thromboembolism, toxemia of pregnancy, labor, trauma, acute infection, severe drug reaction or myocardial infection.
The clinical manifestations of thyroid storm are those consistent with marked hypermetabolism. Patients in thyroid storm may complain of chest pain, palpitations, shortness of breath, tremor, nervousness, increased sweating, disorientation, fatigue and fever. Usually there is marked tachycardia, often with atrial fibrillation and high pulse pressure. On rare occasions symptoms may progress to heart failure. Central nervous system symptoms include marked agitation, restlessness, delirium, psychosis, and coma. Gastrointestinal symptoms include nausea, vomiting, diarrhea and jaundice. Fatal outcomes, which usually occur in the elderly, are associated with heart failure and shock.