Perioperative Care of a Child With Hyperthyroidism

Area of Science:

• Pediatric Endocrinology
• Autoimmune Disorders
• Surgical Management

Background:

• Graves' disease (GD) is the primary cause of hyperthyroidism in children, leading to excessive thyroid hormone levels.
• Hyperthyroidism symptoms include irritability, tremors, tachycardia, and arrhythmias, increasing risks with surgical intervention.
• Thyroid storm (TS) is a life-threatening exacerbation of hyperthyroidism, posing significant perioperative risks.

Observation:

• A pediatric patient with GD experienced worsening thyrotoxicosis and developed TS despite methimazole treatment, due to intolerance and a serum sickness-like illness.
• The patient presented with fever, tachycardia, diaphoresis, and hypertension prior to surgery.
• Admission to the pediatric intensive care unit was required for TS management.

Findings:

• Management of TS involved hydrocortisone, potassium iodide, and beta-adrenergic blockade (esmolol, propranolol).
• Thyroid function improved, enabling successful total thyroidectomy.
• Postoperative care included gradual corticosteroid tapering and levothyroxine replacement therapy.

Implications:

• This case underscores the importance of recognizing pediatric TS signs and symptoms.
• It emphasizes the need for tailored treatment strategies, especially when first-line pharmacologic therapies are not tolerated.
• Effective perioperative management of pediatric TS is crucial for favorable surgical outcomes.