Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves' disease: a case report

Amanda W Schaefer; Pedro J Solorzano; Ana C Mavarez; Gustavo M Muñoz-Monaco

doi:10.1186/s40981-022-00543-2

Diagnosis and management of intraoperative thyroid storm in a child with undiagnosed Graves' disease: a case report

JA Clin Rep. 2022 Jul 16;8(1):52. doi: 10.1186/s40981-022-00543-2.

Authors

Amanda W Schaefer¹, Pedro J Solorzano², Ana C Mavarez³, Gustavo M Muñoz-Monaco³

Affiliations

¹ Medical College of Georgia at Augusta University, Augusta, GA, USA. [email protected].
² Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
³ Department of Anesthesiology and Perioperative Medicine, Pediatric Anesthesiology Division, Children's Hospital of Georgia, Medical College of Georgia at Augusta University, Augusta, GA, USA.

Abstract

Background: Thyroid storm is a life-threatening manifestation of thyrotoxicosis and presents with fever, diaphoresis, tachycardia, hypertension, and widened pulse pressure.

Case presentation: We present a case of intraoperative thyroid storm in a 12-year-old female undergoing posterior spinal fusion. Despite adequate depth of anesthesia and analgesia, the patient was persistently tachycardic and hypertensive. The surgical procedure was uneventful. A thyroid panel drawn immediately after surgery showed undetectable thyroid stimulating hormone (TSH) and high free thyroxine (T4) consistent with thyroid storm.

Conclusions: Intraoperative thyroid storm in a pediatric patient is extremely rare with nonspecific clinical symptoms. Low to undetectable TSH and elevated free T4 is diagnostic.

Keywords: Graves’ disease; Pediatrics; Thyroid storm; Thyrotoxicosis.