Pandya Manthan, Garcia R Angel, Awori Jeremy
AACE Clin Case Rep. 2019 Sep 26;5(6):e393-e395. doi: 10.4158/ACCR-2019-0261. eCollection 2019 Nov-Dec.
The objective of this report was to emphasize the early recognition of thyrotoxicosis in the assessment of a pediatric patient with tachycardia. We present here the case of a 17-year-old female who presented with supraventricular tachycardia and was found to be in a state of severe thyrotoxicosis with borderline features of a thyroid storm.
A 17-year-old African American female presented to the hospital with complaints of nausea, vomiting, and diarrhea associated with palpitations for 1 week. Initial workup included electrocardiogram, total blood count, lipase, basic metabolic panel, and thyroid function tests.
Initial vital signs were significant for a temperature of 100.1°F, and tachycardia with a heart rate (HR) of 180 beats per minute (bpm). Initial telemetry was significant for supraventricular tachycardia with a HR of 180 bpm. Vagal maneuvers including carotid sinus massage were attempted first followed by 6 mg intravenous (IV) push and then 12 mg IV push of adenosine. However, the patient remained tachycardic with a HR in the 150s. Laboratory evaluation confirmed the presence of thyrotoxicosis with a thyroid-stimulating hormone of 0.17 μIU/mL (normal, 0.5 to 4.7 μIU/mL) with a free thyroxine of 4.90 ng/dL (normal, 0.8 to 2.0 ng/dL) and free triiodothyronine >20 pg/mL (normal, 1.95 to 5.85 pg/mL). She was subsequently treated with propranolol, methimazole, and hydrocortisone, which resolved her symptoms in a few hours.
Due to high mortality rates, severe thyrotoxicosis needs to be recognized and treated early. This case report highlights the importance of early recognition of thyrotoxicosis in the initial management of tachycardia in the pediatric population.
本报告的目的是强调在评估一名心动过速的儿科患者时对甲状腺毒症的早期识别。我们在此介绍一名17岁女性的病例，该患者表现为室上性心动过速，被发现处于严重甲状腺毒症状态，伴有甲状腺风暴的临界特征。
一名17岁的非裔美国女性因恶心、呕吐、腹泻伴心悸1周前来医院就诊。初始检查包括心电图、全血细胞计数、脂肪酶、基础代谢指标和甲状腺功能检查。
初始生命体征显示体温为100.1°F，心动过速，心率（HR）为每分钟180次（bpm）。初始遥测显示室上性心动过速，心率为180 bpm。首先尝试了包括颈动脉窦按摩在内的迷走神经手法，随后静脉推注6 mg，然后静脉推注12 mg腺苷。然而，患者仍心动过速，心率在150多次。实验室评估证实存在甲状腺毒症，促甲状腺激素为0.17 μIU/mL（正常，0.5至4.7 μIU/mL），游离甲状腺素为4.90 ng/dL（正常，0.8至2.0 ng/dL），游离三碘甲状腺原氨酸>20 pg/mL（正常，1.95至5.85 pg/mL）。她随后接受了普萘洛尔、甲巯咪唑和氢化可的松治疗，数小时内症状得到缓解。
由于死亡率高，严重甲状腺毒症需要早期识别和治疗。本病例报告强调了在儿科人群心动过速的初始管理中早期识别甲状腺毒症的重要性。
