Soft Tissue - Pediatric Thyrotoxicosis
Caption
A 23mo F with PMH known Graves disease presented with a 10min generalized tonic/clonic seizure. IM Versed en route stopped the seizure. The patient was given 2 mL/kg D10 for hypoglycemia but remained hypoglycemic and refractory to D10 boluses. She was afebrile and not felt to be in thyroid storm but there was concern for thyrotoxicosis with adrenal insufficiency. POCUS was performed to asses cardiac function due to elevated pulse pressures of 60-70 mmHg and the risk of high-output failure risk, although cardiac POCUS was reassuring and clinically the patient didn’t fit high-output failure. Thyroid POCUS was performed after the TSH resulted at 0. The exam is shown here with diffuse increased flow in the thyroid, consistent with thyrotoxicosis and Graves disease. The patient received stress dose steroids (but was already on propranolol and methimazole) and was admitted for definitive management. Dr. Anthony Rodriguez, PGY1, Denver Health Residency in Emergency Medicine Dr. Cailin Frank, Ultrasound Fellow, Denver Health Ultrasound Fellowship