Seizures in pediatric thyroid storm: Two cases and a literature review

Abstract

Thyroid storm is a life-threatening disorder caused by thyrotoxicosis. Diagnostic criteria in adults emphasize central nervous system (CNS) symptoms, including seizures, as CNS symptoms are associated with irreversible damage. However, children have a lower seizure threshold than adults, which may lead to overestimation of severity in pediatric cases with seizures. This study reports two pediatric cases of thyroid storm with seizures, fever, and tachycardia. The more severe case remained unconscious and restless, necessitating intubation and intensive care. The other case regained consciousness spontaneously following the initiation of treatment for thyroid storm. A literature review of 84 children and adolescents with thyroid storm revealed 16 cases (19%) that exhibited seizures. The prevalence of seizures was higher in infants (30.0%) and children (30.4%) than in adolescents (7.3%). Almost all 16 cases with seizures had favorable outcomes, suggesting that seizures in pediatric thyroid storm cases may not be associated with poor prognosis. Although seizures appear to be more common in pediatric thyroid storm and may not necessarily predict poor outcomes, the presence of seizures warrants careful evaluation because of the life-threatening nature of the condition.