Thyroid storm in an adolescent presenting with acute sinus tachycardia triggered by Streptococcal and Influenza co-infection

Thyroid storm is a rare but life-threatening complication of thyrotoxicosis. It is particularly uncommon in pediatric populations with an incidence of approximately 1-2% among patients with overt hyperthyroidism ( 8 ). Thyrotoxicosis has a reported annual incidence of 0.9 per 100,000 in post pubertal children and a prevalence in the US of 1.2% ( 3 )( 13 ). Symptoms of thyroid storm include hypertension, fever, gastrointestinal symptoms, tachycardia, and altered mental status. These signs and symptoms easily mimic common emergency medicine patient presentations such as sepsis, dysrhythmia, viral infections, pneumonia, or recreational drug use, making diagnosis difficult. Delayed recognition of thyroid storm significantly increases morbidity and mortality, making prompt recognition and treatment critical in the emergency medicine setting. We present the case of a 14-year-old adolescent who arrived to the emergency department with fever, rapid heart rate, anxiety, and sore throat. The constellation of physical exam findings led to suspicion for thyroid storm. Treatment including IV fluids, beta-blockade, antithyroid therapy, corticosteroids, and iodine therapy were initiated. Laboratory testing later confirmed the diagnosis of thyroid storm. Testing for Streptococcal pharyngitis and Influenza B also resulted positive, likely representing the triggers. The patient improved with the treatment administered in the emergency department and subsequently transferred to the pediatric ICU. Although rare in pediatric patients, thyroid storm carries a mortality rate of 10-30% ( 7 )( 8 ). Early diagnosis is essential, yet the clinical presentation can be mistaken for more common emergencies such as sepsis, dysrhythmia, myocarditis, endocarditis, pneumonia, or recreational drug use. Emergency physicians must maintain a high index of suspicion for thyroid storm in patients presenting with unexplained tachycardia, fever, and hypertension, even in the absence of known thyroid disease. Emergency physicians play a critical role in stabilizing these patients and initiating time-sensitive treatment that significantly improves outcomes.