{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:01:22Z","timestamp":1760144482546,"version":"build-2065373602"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:00:00Z","timestamp":1714089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>A 15-year-old young girl was found dead at home. There were no indications of any intervention or the application of force. On the previous day, she was admitted to hospital because of palpitations, fatigue, a headache, and a swollen neck. During a physical examination, a swollen thyroid gland and tachycardia were found. In the family history, her mother had thyroid disease. According to the laboratory values, she had elevated thyroid hormone levels. After administration of beta-blockers, the patient was discharged and died at home during the night. The parents denounced the hospital for medical malpractice; therefore, a Forensic Autopsy was performed. Based on the available clinical data, the autopsy, histological and toxicological results, the cause of death was stated as multiorgan failure due to disseminated intravascular coagulation (DIC) caused by the autoimmune Graves disease. The forensic assessment of the case does not reveal medical malpractice. Post-mortem diagnoses of thyroid disorders in cases of sudden death can be challenging. However, as the reported case illustrates, the diagnosis could be established after a detailed evaluation of antemortem clinical data, autopsy results, histology, and a toxicological examination.<\/jats:p>","DOI":"10.3390\/diagnostics14090905","type":"journal-article","created":{"date-parts":[[2024,5,2]],"date-time":"2024-05-02T08:42:57Z","timestamp":1714639377000},"page":"905","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: A Sudden Thyroid-Related Death of a 15-Year-Old Girl"],"prefix":"10.3390","volume":"14","author":[{"given":"K\u00e1lm\u00e1n","family":"R\u00e1cz","sequence":"first","affiliation":[{"name":"Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6153-3260","authenticated-orcid":false,"given":"G\u00e1bor","family":"Simon","sequence":"additional","affiliation":[{"name":"Medical School, Department of Forensic Medicine, University of P\u00e9cs, 7624 P\u00e9cs, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea","family":"Kurucz","sequence":"additional","affiliation":[{"name":"Clinical Center, Department of Cardiology and Cardiac Surgery, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7758-1769","authenticated-orcid":false,"given":"Gerg\u0151 Tam\u00e1s","family":"Hars\u00e1nyi","sequence":"additional","affiliation":[{"name":"Pathology Department, Szabolcs-Szatm\u00e1r-Bereg County Teaching Hospital, 4400 Ny\u00edregyh\u00e1za, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikl\u00f3s","family":"T\u00f6r\u00f6k","sequence":"additional","affiliation":[{"name":"Clinical Center, Department of Pathology, Ken\u00e9zy Gyula Campus, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L\u00e1szl\u00f3 Tam\u00e1s","family":"Herczeg","sequence":"additional","affiliation":[{"name":"Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0437-4072","authenticated-orcid":false,"given":"P\u00e9ter Attila","family":"Gergely","sequence":"additional","affiliation":[{"name":"Clinical Center, Department of Forensic Medicine, University of Debrecen, 4032 Debrecen, Hungary"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,4,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.ecl.2006.09.008","article-title":"Thyrotoxicosis and thyroid storm","volume":"35","author":"Nayak","year":"2006","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"906","DOI":"10.1016\/S0140-6736(16)00278-6","article-title":"Hyperthyroidism","volume":"388","author":"Lee","year":"2016","journal-title":"Lancet"},{"key":"ref_3","unstructured":"Braverman, L., and Utiger, R. (2000). Werner and Ingbar\u2019s the Thyroid, Lippincott Williams and Wilkins. [8th ed.]."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1089\/thy.2012.2207.ed1","article-title":"Clinical criteria for the diagnosis of thyroid storm","volume":"22","author":"Wartofsky","year":"2012","journal-title":"Thyroid"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1056\/NEJM200102153440707","article-title":"Thyroid hormone and the cardiovascular system","volume":"344","author":"Klein","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1089\/thy.2011.0334","article-title":"Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys","volume":"22","author":"Akamizu","year":"2012","journal-title":"Thyroid"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/00004836-199912000-00004","article-title":"Thyroid storm presenting with liver failure","volume":"29","author":"Choudhary","year":"1999","journal-title":"J. Clin. Gastroenterol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1016\/S0196-0644(05)81622-1","article-title":"An unusual cause of abdominal pain in a young woman","volume":"20","author":"Martel","year":"1991","journal-title":"Ann. Emerg. Med."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"(2000). Recommendation no. R (99) 3 of the Committee of Ministers to member states on the harmonization of medico-legal autopsy rules. Forensic Sci. Int., 111, 5\u201358.","DOI":"10.1016\/S0379-0738(00)00186-9"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1007\/s00428-017-2221-0","article-title":"Association for European Cardiovascular Pathology. Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology","volume":"471","author":"Basso","year":"2017","journal-title":"Virchows Arch."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.4158\/EP.17.3.456","article-title":"Hyperthyroidism and other causes of thyrotoxicosis: Management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists","volume":"17","author":"Bahn","year":"2011","journal-title":"Endocr. Pract."},{"key":"ref_12","unstructured":"Blick, C., Nguyen, M., and Jialal, I. (2023). StatPearls [Internet], StatPearls Publishing."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"330","DOI":"10.29271\/jcpsp.2020.03.330","article-title":"Presentations and Outcomes of Thyroid Storm","volume":"30","author":"Shahid","year":"2020","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/S0889-8529(18)30165-8","article-title":"Life-threatening thyrotoxicosis. Thyroid storm","volume":"22","author":"Burch","year":"1993","journal-title":"Endocrinol. Metab. Clin. N. Am."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Tankeu, A.T., Azabji-Kenfack, M., Nganou, C.N., Ngassam, E., Kuate-Mfeukeu, L., Mba, C., Dehayem, M.Y., Mbanya, J.C., and Sobngwi, E. (2018). Effect of propranolol on heart rate variability in hyperthyroidism. BMC Res. Notes, 11.","DOI":"10.1186\/s13104-018-3224-x"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"217","DOI":"10.23907\/2016.024","article-title":"An Overview of the Thyroid Gland and Thyroid-Related Deaths for the Forensic Pathologist","volume":"6","author":"Beynon","year":"2016","journal-title":"Acad. Forensic Pathol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1111\/1556-4029.12247","article-title":"Sudden unexpected death due to Graves\u2019 disease during physical altercation","volume":"5","author":"Wei","year":"2013","journal-title":"J. Forensic Sci."},{"key":"ref_18","first-page":"130060","article-title":"Thromboembolic complications of thyroid storm","volume":"2014","author":"Min","year":"2014","journal-title":"Endocrinol. Diabetes Metab. Case Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1089\/thy.2009.0383","article-title":"Graves\u2019 disease and thymic hyperplasia: The relationship of thymic volume to thyroid function","volume":"20","author":"Popoveniuc","year":"2010","journal-title":"Thyroid"},{"key":"ref_20","unstructured":"Feingold, K.R., Anawalt, B., Blackman, M.R., Boyce, A., Chrousos, G., Corpas, E., de Herder, W.W., Dhatariya, K., and Dungan, K. (2000). Endotext [Internet], MDText.com, Inc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1056\/NEJM199509283331307","article-title":"Polycystic ovary syndrome","volume":"333","author":"Franks","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/S0140-6736(07)61345-2","article-title":"Polycystic ovary syndrome","volume":"370","author":"Norman","year":"2007","journal-title":"Lancet"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2967","DOI":"10.1093\/humrep\/dem271","article-title":"Efficacy of metformin in obese and non-obese women with polycystic ovary syndrome: A randomized, double-blinded, placebo-controlled cross-over trial","volume":"22","author":"Trolle","year":"2007","journal-title":"Hum. Reprod."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1111\/j.1365-2265.2007.02985.x","article-title":"The effects of metformin on metabolic and cardiovascular risk factors in nonobese women with polycystic ovary syndrome","volume":"67","author":"Sahin","year":"2007","journal-title":"Clin. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.ejim.2010.06.008","article-title":"Polycystic ovary syndrome and autoimmunity","volume":"21","author":"Petrikova","year":"2010","journal-title":"Eur. J. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S0165-0378(01)00075-4","article-title":"Autoantibody studies of female patients with reproductive failure","volume":"51","author":"Reimand","year":"2001","journal-title":"J. Reprod. Immunol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"982","DOI":"10.4103\/2230-8210.103006","article-title":"Association of polycystic ovary syndrome and Graves\u2019 disease: Is autoimmunity the link between the two diseases","volume":"16","author":"Nisar","year":"2012","journal-title":"Indian J. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1530\/eje.0.1500363","article-title":"High prevalence of autoimmune thyroiditis in patients with polycystic ovary syndrome","volume":"150","author":"Janssen","year":"2004","journal-title":"Eur. J. Endocrinol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.ejogrb.2013.03.003","article-title":"High prevalence of chronic thyroiditis in patients with polycystic ovary syndrome","volume":"169","author":"Garelli","year":"2013","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"204","DOI":"10.3109\/07435800.2015.1015730","article-title":"High prevalence of Hashimoto\u2019s thyroiditis in patients with polycystic ovary syndrome: Does the imbalance between estradiol and progesterone play a role?","volume":"40","author":"Arduc","year":"2015","journal-title":"Endocr. Res."},{"key":"ref_31","first-page":"213","article-title":"Alta frecuencia de trastornos tiroideos en el s\u00edndrome de ovario poliqu\u00edstico [High frequency of thyroid abnormalities in polycystic ovary syndrome]","volume":"75","author":"Calvar","year":"2015","journal-title":"Medicina"},{"key":"ref_32","first-page":"346","article-title":"Thyroid disorders in polycystic ovary syndrome","volume":"21","author":"Kowalczyk","year":"2017","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"C118","DOI":"10.1093\/eurheartjsupp\/suad014","article-title":"Autopsy and sudden death","volume":"25","author":"Thiene","year":"2023","journal-title":"Eur. Heart J. Suppl."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/S0025-6196(12)64945-3","article-title":"Age-related changes in normal human hearts during the first 10 decades of life. Part I (Growth): A quantitative anatomic study of 200 specimens from subjects from birth to 19 years old [published correction appears in Mayo Clin Proc 1988 Jun;63(6):637]","volume":"63","author":"Scholz","year":"1988","journal-title":"Mayo Clin. Proc."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/9\/905\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:33:34Z","timestamp":1760106814000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/14\/9\/905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,26]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2024,5]]}},"alternative-id":["diagnostics14090905"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics14090905","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2024,4,26]]}}}