{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,24]],"date-time":"2025-11-24T21:41:26Z","timestamp":1764020486657,"version":"3.40.5"},"reference-count":10,"publisher":"Walter de Gruyter GmbH","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec id=\"j_jpem-2021-0219_abs_001\">\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves\u2019 disease.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0219_abs_002\">\n                  <jats:title>Case presentation<\/jats:title>\n                  <jats:p>They were previously healthy adolescents without family history of thyroid disease. CNS symptoms varied from agitation to coma. GI symptoms included abdominal pain, vomiting, and diarrhea. Their laboratory studies revealed thyrotoxicosis and positive result of thyroid-stimulating antibody (TSAb). They were admitted to the intensive care unit (ICU) and received the combination of an antithyroid drug, Lugol\u2019s solution, a beta antagonist, and hydrocortisone. The most severe case was a 13\u00a0year-old Japanese girl who presented with loss of consciousness and hemodynamic shock. She died after 5\u00a0days of intensive treatment.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec id=\"j_jpem-2021-0219_abs_003\">\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Pediatricians should consider TS in the differential diagnosis when a patient exhibits both CNS and GI symptoms.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1515\/jpem-2021-0219","type":"journal-article","created":{"date-parts":[[2021,6,23]],"date-time":"2021-06-23T22:21:26Z","timestamp":1624486886000},"page":"1197-1200","source":"Crossref","is-referenced-by-count":5,"title":["Neurological and gastrointestinal symptoms as an initial presentation of pediatric thyroid storm: report of three cases"],"prefix":"10.1515","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6749-5920","authenticated-orcid":false,"given":"Masao","family":"Nogami","sequence":"first","affiliation":[{"name":"Department of Pediatrics , Teine Keijinkai Hospital , Sapporo , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shadia","family":"Constantine","sequence":"additional","affiliation":[{"name":"Primary Center, Sapporo Tokushukai Hospital , Sapporo , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shuji","family":"Sai","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Teine Keijinkai Hospital , Sapporo , Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2021,6,24]]},"reference":[{"key":"2021090720501746795_j_jpem-2021-0219_ref_001","doi-asserted-by":"crossref","unstructured":"Akamizu, T, Satoh, T, Isozaki, O, Suzuki, A, Wakino, S, Iburi, T, et al.. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid 2012;22:661\u201379. https:\/\/doi.org\/10.1089\/thy.2011.0334.","DOI":"10.1089\/thy.2011.0334"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_002","doi-asserted-by":"crossref","unstructured":"Burch, HB, Wartofsky, L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin N Am 1993;22:263\u201377. https:\/\/doi.org\/10.1016\/s0889-8529(18)30165-8.","DOI":"10.1016\/S0889-8529(18)30165-8"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_003","doi-asserted-by":"crossref","unstructured":"Chiha, M, Samarasinghe, S, Kabaker, AS. Thyroid storm: an updated review. J Intensive Care Med 2015;30:131\u201340. https:\/\/doi.org\/10.1177\/0885066613498053.","DOI":"10.1177\/0885066613498053"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_004","doi-asserted-by":"crossref","unstructured":"Srinivasan, S, Misra, M. Hyperthyroidism in children. Pediatr Rev 2015;36:239\u201348. https:\/\/doi.org\/10.1542\/pir.36-6-239.","DOI":"10.1542\/pir.36-6-239"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_005","doi-asserted-by":"crossref","unstructured":"Satoh, T, Isozaki, O, Suzuki, A, Wakino, S, Iburi, T, Tsuboi, K, et al.. 2016 Guidelines for the management of thyroid storm from The Japan Thyroid Association and Japan Endocrine Society (First Edition). Endocr J 2016;63:1025\u201364. https:\/\/doi.org\/10.1507\/endocrj.ej16-0336.","DOI":"10.1507\/endocrj.EJ16-0336"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_006","doi-asserted-by":"crossref","unstructured":"Ladd, JM, Sabsabi, B, von Oettingen, JE. Thyroid storm in a toddler presenting as a febrile seizure. Pediatrics 2020;145:e20191920. https:\/\/doi.org\/10.1542\/peds.2019-1920.","DOI":"10.1542\/peds.2019-1920"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_007","doi-asserted-by":"crossref","unstructured":"Hecht, T, Brand, J, Vlaho, S. Encephalopathy and sinus tachycardia in childhood a possible differential diagnosis. J Pediatr Endocrinol Metab 2012;25:149\u201351. https:\/\/doi.org\/10.1515\/jpem-2011-0436.","DOI":"10.1515\/jpem-2011-0436"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_008","doi-asserted-by":"crossref","unstructured":"Esen, \u0130, Bayramo\u011flu, E, Y\u0131ld\u0131z, M, Ayd\u0131n, M, Karak\u0131l\u0131\u00e7 \u00d6zturhan, E, Aycan, Z, et al.. Management of thyrotoxicosis in children and adolescents: a Turkish multi-center experience. J Clin Res Pediatr Endocrinol 2019;11:164\u201372. https:\/\/doi.org\/10.4274\/jcrpe.galenos.2018.2018.0210.","DOI":"10.4274\/jcrpe.galenos.2018.2018.0210"},{"key":"2021090720501746795_j_jpem-2021-0219_ref_009","doi-asserted-by":"crossref","unstructured":"Auron, M, Raissouni, N. Adrenal insufficiency. 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