%0 Journal Article
%T Respiratory Syncytial Virus Infection as a Precipitant of Thyroid Storm in a Previously Undiagnosed Case of Graves' Disease in a Prepubertal Girl
%A Ivy R Aslan
%A Elizabeth A Baca
%A RWilliam Charlton
%A Stephen M Rosenthal
%J International Journal of Pediatric Endocrinology
%D 2011
%I BioMed Central
%R 10.1155/2011/138903
%X A prepubertal 11-year-old Hispanic girl presented to the emergency department with a one-day history of respiratory distress, fever, and dysphagia that developed after several days of upper respiratory infection symptoms and sore throat.Her past medical history was notable for prematurity (26 weeks gestational age) associated with chronic lung disease. On exam she was noted to be thin, agitated, drooling, in moderate-to-severe distress, and holding herself in a tripod position. Her temperature was 38.6 (C) or 101.4 (F), heart rate 200, blood pressure 162/93£¿mmHg, respiratory rate 40, O2 sat 91% in room air. She had diffuse erythema of the pharynx, exophthalmos and a diffuse bilateral goiter, each lobe measuring . There were no palpable nodules or tenderness, but a bruit was present. On her lung exam she had bilateral wheezes. She was prepubertal.Laboratory TestsNasal swab Direct Fluorescent Antibody was positive for respiratory syncytial virus (RSV). Table 1 shows thyroid function tests at diagnosis and 1 week after treatment was started (see hospital course).The patient's chest X-ray showed linear subsegmental densities in both lungs bases as well as prominence of interstitial markings in the lung apices. Multiple cuffed bronchi are seen in the perihilar regions and in the left upper lobe. All these findings are compatible with viral pneumonia.The following studies were also obtained at baseline: thyroid stimulating immunoglobulin 257% baseline (normal <125%), anti-thyroperoxidase antibody 4.77£¿IU/ml (normal <0.8), and anti-thyroglobulin antibody 68£¿IU/mL (normal <20).The patient's score of 60 met criteria for thyroid storm based on Burch and Wartofsky's criteria. A score of 45 or more is highly suggestive of thyroid storm (see Table 2) [1].Hospital CourseThe patient was initially treated with propylthiouracil (PTU), saturated solution of potassium iodide (SSKI), dexamethasone, esmolol infusion, and bronchodilators. She was discharged home on PTU 100£¿mg PO Q8h, ate
%U http://www.ijpeonline.com/content/2011/1/138903