{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:45:02Z","timestamp":1776386702795,"version":"3.51.2"},"reference-count":12,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,3,8]]},"abstract":"<jats:p>A previously well, 4-year-old girl presented with a 4\u20136 weeks\u2019 history of increased appetite, weight loss, tiredness, sleep difficulty, excessive sweating, swelling in the neck and new-onset \u2018prominent, protruding eyes.\u2019 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\u2009pmol\/L, thyroid-stimulating hormone &lt;0.05\u2009mIU\/L) with raised thyroid peroxidase antibody levels (TPO=541\u2009IU\/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\u2019 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.<\/jats:p>","DOI":"10.1136\/bcr-2017-222850","type":"journal-article","created":{"date-parts":[[2018,3,24]],"date-time":"2018-03-24T01:29:26Z","timestamp":1521854966000},"page":"bcr-2017-222850","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Thyrotoxic crisis as an acute clinical presentation in a child"],"prefix":"10.1136","volume":"2018","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1208-1536","authenticated-orcid":false,"given":"Adam","family":"Bonfield","sequence":"first","affiliation":[{"name":"Paediatrics, University Hospitals of Leicester Foundation Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savitha","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Paediatrics, University Hospitals of Leicester Foundation Trust, Leicester, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,23]]},"reference":[{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.1","unstructured":"Burch H , Wartofsky L . Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin. 1993 http:\/\/europepmc.org\/abstract\/med\/8325286 (cited 15 Sep 2017)."},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03717.x"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.3","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1111\/ped.13102","article-title":"Low cardiac output thyroid storm in a girl with Graves' disease","volume":"58","author":"Chantra","year":"2016","journal-title":"Pediatr Int"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.4","unstructured":"Raine J , Donaldson M , Gregory J , et al . Practical endocrinology and diabetes in children. 2011 https:\/\/books.google.co.uk\/books?hl=en&lr=&id=tS10bNAJk1UC&oi=fnd&pg=PP12&dq=Practical+Endocrinology+and+Diabetes+in+Children.+Malden,+MA,+USA:+Blackwell+Publishing+Ltd%3B+2006&ots=evcwfQw7Qi&sig=QpZVbjSRCIkuIrBmlbf7KZj9aGg (cited 15 Sep 2017)."},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.5","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s40618-016-0477-x","article-title":"Controversies in the management of Graves' disease in children","volume":"39","author":"Rivkees","year":"2016","journal-title":"J Endocrinol Invest"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.6","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1515\/jpem-2016-0122","article-title":"An update on thyroid-associated ophthalmopathy in children and adolescents","volume":"29","author":"Szczapa-Jagustyn","year":"2016","journal-title":"J Pediatr Endocrinol Metab"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.7","unstructured":"LaFranchi S . In: Geffner M , Hoppin A , eds. Clinical manifestations and diagnosis of hyperthyroidism in children and adolescents: UpToDate, 2016. https:\/\/www.uptodate.com\/contents\/clinical-manifestations-and-diagnosis-of-hyperthyroidism-in-children-and-adolescents#H18"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.8","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1111\/cen.13327","article-title":"Measuring TSH receptor antibody to influence treatment choices in Graves' disease","volume":"86","author":"Hesarghatta Shyamasunder","year":"2017","journal-title":"Clin Endocrinol"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.9","doi-asserted-by":"publisher","DOI":"10.1177\/0885066613498053"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.10","doi-asserted-by":"publisher","DOI":"10.1177\/0883073810384867"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2006.09.008"},{"key":"2025082707435040000_2018.mar23_1.bcr-2017-222850.12","doi-asserted-by":"publisher","DOI":"10.1542\/pir.36-6-239"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2017-222850","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:44:07Z","timestamp":1756305847000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2017-222850"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3,23]]},"references-count":12,"alternative-id":["10.1136\/bcr-2017-222850"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2017-222850","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3,23]]}}}