BMJ Case Reports 2018; doi:10.1136/bcr-2017-222850
  • Reminder of important clinical lesson

Thyrotoxic crisis as an acute clinical presentation in a child

  1. Savitha Shenoy
  1. Paediatrics, University Hospitals of Leicester Foundation Trust, Leicester, UK
  1. Correspondence to Dr Adam Bonfield, ab798{at}
  • Accepted 8 March 2018
  • Published 23 March 2018


A previously well, 4-year-old girl presented with a 4–6 weeks’ history of increased appetite, weight loss, tiredness, sleep difficulty, excessive sweating, swelling in the neck and new-onset ‘prominent, protruding eyes.’ Family history revealed paternal grandmother receiving treatment for hyperthyroidism. Clinical assessment demonstrated features of thyrotoxicosis (tachycardia, warm peripheries, small smooth goitre with no nodules, exophthalmos). TFT (Free T4=101 pmol/L, thyroid-stimulating hormone <0.05 mIU/L) with raised thyroid peroxidase antibody levels (TPO=541 IU/mL) confirmed autoimmune hyperthyroidism. Observation on the ward showed features of thyrotoxic crisis with persistent severe tachycardia on ECG (sinus tachycardia with left ventricular hypertrophy (LVH)) and hypertension. Ultrasound thyroid showed diffuse thyroiditis with no focal lesion. Echocardiogram confirmed the above findings. A diagnosis of Graves’ disease with thyrotoxic crisis was made. Antithyroid treatment (carbimazole) and beta-blocker (propranolol) was commenced. Thyrotoxic crisis resolved over 2 weeks and the child has continued to respond to carbimazole treatment at 1-year follow-up.


  • Contributors AB was the doctor who clerked and assessed this child on admission. He has searched the literature to ensure an accurate summary within the discussion and has written up the whole case study. SS is the consultant who cares for the patient. She has reviewed the case study and made amendments to the sections prior to submission for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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