Thyroid storm following radioactive iodine (RAI) therapy for pediatric graves disease
Open accessAbstract
PATIENT: Female, 11 FINAL DIAGNOSIS: Thyroid storm Symptoms: Diarrhea • tachycardia • tachypnea • tremor • wheezing MEDICATION: - Clinical Procedure: - Specialty: - OBJECTIVE: Rare disease. BACKGROUND: A growing number of pediatric endocrinologists treat Graves disease with radioactive iodine (RAI) therapy due to the typically definitive nature of I-131 therapy. Given the published benefits and perceived low risks of RAI when compared to surgery or long-term anti-thyroid medication, the trend towards therapy with RAI is likely to continue. Nevertheless, RAI is not without significant risk. CASE REPORT: An 11-year-old girl with newly diagnosed Graves disease received RAI for definitive treatment of her hyperthyroidism. Within 24 hours of receiving I-131, she developed increasing sleepiness and eventually became unresponsive. Upon arrival at the emergency department she had a tonic-clonic seizure and was diagnosed with thyroid storm. Despite best efforts to manage her hyperthyroidism, she suffered a stroke of the left cerebral hemisphere that left her with persistent neurological deficits. CONCLUSIONS: Although thyroid storm after thyroid ablation is rare, the significant morbidity and potential mortality of pediatric thyroid storm warrant further studies to determine if children with markedly elevated thyroid hormone concentrations at diagnosis should receive prolonged pretreatment with anti-thyroid drugs. While such an approach may reduce the efficacy of I-131 ablation, it can also reduce and hopefully eliminate the risk of post-ablative thyroid storm.
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There are rare reports of pediatric patients with severe hyperthyroidism who have developed thyroid storm after receiving RAI.
“Although the frequency of short-term worsening of hyperthyroidism following pretreatment with ATD therapy is not known, there are rare reports of pediatric patients with severe hyperthyroidism who have developed thyroid storm after receiving RAI (347,348).”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [348]
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Cites
Bahn, R. S., Burch, H. B., Cooper, D. S., Garber, J. R., Greenlee, M. C., Klein, I., Laurberg, P., McDougall, I. R., Montori, V. M., Rivkees, S. A., et al. (2011) · Endocrine Practice · doi:10.4158/ep.17.3.456 · Cited by 1,098 · see citing works
Baskin, H. J., Cobin, R. H., Duick, D. S., Gharib, H., Guttler, R. B., Kaplan, M. M., Segal, R. L., Garber, J. R., Hamilton Jr, C. R., Handelsman, Y., et al. (2002) · Endocrine Practice · doi:10.4158/1934-2403-8.6.457 · Cited by 673 · see citing works
Cobin, R. H., Futterweit, W., Ginzburg, S. B., Goodman, N. F., Kleerekoper, M., Licata, A. A., Meikle, A. W., Petak, S. M., Porte, K. L., Sellin, R. V., et al. (2006) · Endocrine Practice · doi:10.4158/ep.12.3.315 · Cited by 184 · see citing works
Thyrotoxicosis in Prepubertal Children Compared with Pubertal and Postpubertal Patients
Lazar, L., Kalter-Leibovici, O., Pertzelan, A., Weintrob, N., Josefsberg, Z., & Phillip, M. (2000) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.85.10.6922 · Cited by 162 · see citing works
The effect of thyrotoxicosis on adrenocortical reserve
Tsatsoulis, A. A., Johnson, E., Kalogera, C., Seferiadis, K. I., & Tsolas, O. (2000) · European Journal of Endocrinology · doi:10.1530/eje.0.1420231 · Cited by 82 · see citing works
Kadmon, P. M., Noto, R. B., Boney, C. M., Goodwin, G., & Gruppuso, P. A. (2001) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.86.5.7473 · Cited by 58 · see citing works
Thyroid storm following radioiodine for thyrotoxicosis
Hayek, A. (1978) · The Journal of Pediatrics · doi:10.1016/s0022-3476(78)81226-8 · Cited by 19 · see citing works
Recurrence of 131I-induced thyroid storm after discontinuing glucocorticoid therapy.
Ai, K., Caplan, R. H., Reynertson, R. H., & Wickus, G. G. (1991) · PubMed · Cited by 5 · see citing works
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Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., et al. (2016) · Thyroid® · doi:10.1089/thy.2016.0229 · Cited by 2,938 · see citing works
“Although the frequency of short-term worsening of hyperthyroidism following pretreatment with ATD therapy is not known, there are rare reports of pediatric patients with severe hyperthyroidism who have developed thyroid storm after receiving RAI (347,348).”
Background
- Authors
- Haller, M. J.
- Affiliations
- University of Florida Health (US)
- Corresponding author
- Haller, Michael J.
- Venue
- American Journal of Case Reports
- Published
- 2014
- Volume
- 15
- Pages
- 212-215
- ISSN
- 1941-5923 (ISSN-L)
- PMC
- PMC4026146
- OpenAlex
- W2115601956
- Cited by
- 20
- References
- 8
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 2 · 2022: 4 · 2021: 2 · 2019: 2 · 2016: 3 · 2015: 2 · 2014: 1
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- American Journal of Case Reports (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Keywords
- thyroid storm, radioiodine therapy, iodine-131, Graves' disease, pediatric hyperthyroidism, thyroid ablation, stroke, tonic-clonic seizures, neurological deficit
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