Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome
-
Maria Susan Abraham
,
Rajeshwari Narayanan
Abstract
Objectives
Myxedema crisis, a fatal complication of severe hypothyroidism, is extremely rare in children and treatment guidelines are lacking. Since availability of intravenous levothyroxine is limited in resource poor settings, myxedema crisis can be treated with oral levothyroxine and/or oral liothyronine (if necessary), in the absence of cardiac risk factors, thus hastening the recovery and significantly decreasing the associated morbidity and mortality. In the background of untreated hypothyroidism, a possible association of ovarian hyperstimulation syndrome (OHSS) and reactive pituitary hyperplasia should be kept in mind, thus preventing unnecessary interventions.
Case presentation
A 13-year-old girl child with Down syndrome, presented with myxedema crisis, as initial presentation of untreated hypothyroidism.
Conclusions
Annual screening, timely diagnosis of hypothyroidism, and early initiation of thyroid hormone supplementation will prevent associated physical and neurocognitive morbidity in children, especially those with Down syndrome. Importance of oral liothyronine supplementation in myxedema crisis, has been highlighted in this case report.
-
Research funding: None declared.
-
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
-
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Divecha, CA, Tullu, MS, Deshmukh, CT, Karande, S. Myxedema coma in a pediatric patient with Down syndrome. J Pediatr Intensive Care 2020;9:70–3. https://doi.org/10.1055/s-0039-1698812.Search in Google Scholar PubMed PubMed Central
2. Mathew, V, Misgar, RA, Ghosh, S, Mukhopadhyay, P, Roychowdhury, P, Pandit, K, et al.. Myxedema coma: a new look into an old crisis. J Thyroid Res 2011;2011:493462. https://doi.org/10.4061/2011/493462.Search in Google Scholar PubMed PubMed Central
3. Root, JM, Vargas, M, Garibaldi, LR, Saladino, RA. Pediatric patient with altered mental status and hypoxemia: case report. Pediatr Emerg Care 2017;33:486–8. https://doi.org/10.1097/pec.0000000000000722.Search in Google Scholar
4. Simşek, E, Simşek, T, Savaş-Erdeve, S, Erdoğmuş, B, Döşoğlu, M. Pituitary hyperplasia mimicking pituitary macroadenoma in two adolescent patients with long-standing primary hypothyroidism: case reports and review of literature. Turk J Pediatr 2009;51:624–30.Search in Google Scholar
5. Schutt-Aine, JC. Hypothyroid myxedema and hyponatremia in an eight-year-old child: a case report. J Natl Med Assoc 1980;72:705–8.Search in Google Scholar
6. Thompson, MD, Henry, RK. Myxedema coma secondary to central hypothyroidism: a rare but real cause of altered mental status in pediatrics. Horm Res Paediatr 2017;87:350–3. https://doi.org/10.1159/000449223.Search in Google Scholar PubMed
7. Zhu, Y, Qiu, W, Deng, M, Zhu, X. Myxedema coma: a case report of pediatric emergency care. Medicine (Baltimore) 2017;96:e6952. https://doi.org/10.1097/md.0000000000006952.Search in Google Scholar
8. Heksch, RA, Henry, RK. Myxedema coma due to hashimoto thyroiditis: a rare but real presentation of failure to thrive in infancy. Horm Res Paediatr 2018;90:332–6. https://doi.org/10.1159/000488467.Search in Google Scholar PubMed
9. Wankanit, S, Mahachoklertwattana, P, Anantasit, N, Katanyuwong, P, Poomthavorn, P. Myxoedema coma in a 2-year-old girl with untreated congenital hypothyroidism: case report and literature review. J Paediatr Child Health 2019;55:707–10. https://doi.org/10.1111/jpc.14339.Search in Google Scholar PubMed
10. Janson, A, Hällström, C, Iversen, M, Finder, M, Elimam, A, Nergårdh, R. Initial low-dose oral levothyroxine in a child with Down syndrome, myxedema, and cardiogenic shock. Clin Case Rep 2019;7:1291–6. https://doi.org/10.1002/ccr3.2169.Search in Google Scholar PubMed PubMed Central
© 2021 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Editorial
- Obesity after the Covid-19 pandemic and beyond
- Review Article
- Clinical profile and management challenges of disorders of sex development in Africa: a systematic review
- Original Articles
- Development and validation of a mobile application for point of care evaluation of growth failure
- Children-Dietary Inflammatory Index (C-DII), cardiometabolic risk, and inflammation in adolescents: a cross-sectional study
- Accelerated pubertal onset in short children with delayed bone age
- Screening for hypophosphatasia: does biochemistry lead the way?
- Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting
- NPR2 gene variants in familial short stature: a single-center study
- The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience
- Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients
- Development and assessment of a low-health-literacy, pictographic adrenal insufficiency action plan
- Effect of insulin resistance on lung function in asthmatic children
- A major health problem facing immigrant children: nutritional rickets
- Clinical profile, etiology, and diagnostic challenges of primary adrenal insufficiency in Sudanese children: 14-years’ experience from a resource limited setting
- Non-inferiority of liquid thyroxine in comparison to tablets formulation in the treatment of children with congenital hypothyroidism
- Short Communication
- Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: preliminary results of a tertiary center study
- Case Reports
- Gordon syndrome caused by a CUL3 mutation in a patient with short stature in Korea: a case report
- Nitisinone treatment during two pregnancies and breastfeeding in a woman with tyrosinemia type 1 – a case report
- Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome
- First successful concomitant therapy of immune tolerance induction therapy and desensitization in a CRIM-negative infantile Pompe patient
Articles in the same Issue
- Frontmatter
- Editorial
- Obesity after the Covid-19 pandemic and beyond
- Review Article
- Clinical profile and management challenges of disorders of sex development in Africa: a systematic review
- Original Articles
- Development and validation of a mobile application for point of care evaluation of growth failure
- Children-Dietary Inflammatory Index (C-DII), cardiometabolic risk, and inflammation in adolescents: a cross-sectional study
- Accelerated pubertal onset in short children with delayed bone age
- Screening for hypophosphatasia: does biochemistry lead the way?
- Subcutaneous regular insulin use for the management of diabetic ketoacidosis in resource limited setting
- NPR2 gene variants in familial short stature: a single-center study
- The effect of the COVID-19 pandemic on metabolic control in children with type 1 diabetes: a single-center experience
- Evaluating a standardized protocol for the management of diabetes insipidus in pediatric neurosurgical patients
- Development and assessment of a low-health-literacy, pictographic adrenal insufficiency action plan
- Effect of insulin resistance on lung function in asthmatic children
- A major health problem facing immigrant children: nutritional rickets
- Clinical profile, etiology, and diagnostic challenges of primary adrenal insufficiency in Sudanese children: 14-years’ experience from a resource limited setting
- Non-inferiority of liquid thyroxine in comparison to tablets formulation in the treatment of children with congenital hypothyroidism
- Short Communication
- Increased frequency of idiopathic central precocious puberty in girls during the COVID-19 pandemic: preliminary results of a tertiary center study
- Case Reports
- Gordon syndrome caused by a CUL3 mutation in a patient with short stature in Korea: a case report
- Nitisinone treatment during two pregnancies and breastfeeding in a woman with tyrosinemia type 1 – a case report
- Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome
- First successful concomitant therapy of immune tolerance induction therapy and desensitization in a CRIM-negative infantile Pompe patient
