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In iodine-induced thyrotoxicosis, steroid therapy today could keep the surgical knife at bay

  • Rohan K. Henry EMAIL logo and Monika Chaudhari
Published/Copyright: February 21, 2018
Journal of Pediatric Endocrinology and Metabolism
From the journal Journal of Pediatric Endocrinology and Metabolism Volume 31 Issue 5

Abstract

Background:

Amiodarone-induced thyrotoxicosis (AIT) type 2, characterized as a destructive thyroiditis, is well described in the medical literature; however, iodine-induced thyrotoxicosis (IIT) is not, though the latter has similar features and can be managed similarly.

Case presentation:

We present a 17-year-old female who presented with a history of an intermittent goiter with thyroid function tests (TFTs): thyroid-stimulating hormone (TSH)<0.015 (0.4–4 μU/mL), free thyroxine (T4)≥6 (0.7–2.1 ng/dL) and total triiodothyronine (T3) 651 (50–200 mg/dL). Thyroid antibodies were all negative. Despite methimazole therapy for 6 weeks, hyperthyroidism proved refractory to medical management. 123I scan uptake was suppressed. With hyperthyroidism being recalcitrant to therapy, a nutritional history revealed consumption of an iodine supplement containing at least 7 times the recommended daily allowance (RDA) for 5 years, contributing to the Jod-Basedow phenomenon. Urinary spot and 24-hour urinary iodine were both elevated. Though a surgical consult was obtained, surgery was cancelled once TFTs improved and then normalized with steroid therapy. The TFTs and urinary iodine levels remained normal post steroid therapy.

Conclusions:

We suggest that in addition to the need for a thorough nutritional history, a trial of corticosteroids should be utilized in the management of IIT which can present with findings similar to AIT type 2 which is recalcitrant to thionamide therapy. If successful, corticosteroids may delay or prevent surgical management thus avoiding possible complications with the latter approach.

Keywords: amiodarone-induced thyrotoxicosis; Graves’ disease; hyperthyroidism
Corresponding author: Rohan K. Henry, MD, MS, Division of Endocrinology, Department of Pediatrics, Nationwide Children’s Hospital/The Ohio State University College of Medicine, 700 Children’s Drive, Columbus, OH 43205, USA, Phone: 614-722-4425, Fax: 614-722-4440

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. 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.

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Received: 2017-11-20
Accepted: 2018-1-29
Published Online: 2018-2-21
Published in Print: 2018-5-24

©2018 Walter de Gruyter GmbH, Berlin/Boston

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  2. Review
  3. Review and evaluation of patient-centered psychosocial assessments for children with central precocious puberty or early puberty
  4. Mini Review
  5. Childhood obesity: how long should we wait to predict weight?
  6. Original Articles
  7. Glycated hemoglobin A1c as a screening test for detecting type 2 diabetes mellitus in obese children and adolescents
  8. Effect of a multidisciplinary treatment program on eating behavior in overweight and obese preschool children
  9. Cord blood klotho levels are inversely associated with leptin in healthy Latino neonates at risk for obesity
  10. Still too little, too late? Ten years of growth hormone therapy baseline data from the NordiNet® International Outcome Study
  11. Body composition and metabolic health of young male adults with childhood-onset multiple pituitary hormone deficiency after cessation of growth hormone treatment
  12. Hematuria as an adverse outcome following provocative growth hormone stimulation testing in children
  13. Bone mineral density comparison of adolescents with constitutional thinness and anorexia nervosa
  14. Adult height in patients with familial male-limited precocious puberty and the role of an aromatase inhibitor in patient management
  15. Association between UCP polymorphisms and adipokines with obesity in Mexican adolescents
  16. Impact of childhood type 1 diabetes on maternal work-family relations
  17. Case Reports
  18. Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies
  19. Sanjad-Sakati syndrome with macrocytic anemia and failure to thrive: a case from South Jordan
  20. In iodine-induced thyrotoxicosis, steroid therapy today could keep the surgical knife at bay
  21. Graves’ disease following allogenic hematopoietic stem cell transplantation for severe aplastic anemia: case report and literature review
https://doi.org/10.1515/jpem-2017-0485
Keywords for this article
amiodarone-induced thyrotoxicosis; Graves’ disease; hyperthyroidism

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Review and evaluation of patient-centered psychosocial assessments for children with central precocious puberty or early puberty
  4. Mini Review
  5. Childhood obesity: how long should we wait to predict weight?
  6. Original Articles
  7. Glycated hemoglobin A1c as a screening test for detecting type 2 diabetes mellitus in obese children and adolescents
  8. Effect of a multidisciplinary treatment program on eating behavior in overweight and obese preschool children
  9. Cord blood klotho levels are inversely associated with leptin in healthy Latino neonates at risk for obesity
  10. Still too little, too late? Ten years of growth hormone therapy baseline data from the NordiNet® International Outcome Study
  11. Body composition and metabolic health of young male adults with childhood-onset multiple pituitary hormone deficiency after cessation of growth hormone treatment
  12. Hematuria as an adverse outcome following provocative growth hormone stimulation testing in children
  13. Bone mineral density comparison of adolescents with constitutional thinness and anorexia nervosa
  14. Adult height in patients with familial male-limited precocious puberty and the role of an aromatase inhibitor in patient management
  15. Association between UCP polymorphisms and adipokines with obesity in Mexican adolescents
  16. Impact of childhood type 1 diabetes on maternal work-family relations
  17. Case Reports
  18. Hyperthyroidism in an infant of a mother with autoimmune hypothyroidism with positive TSH receptor antibodies
  19. Sanjad-Sakati syndrome with macrocytic anemia and failure to thrive: a case from South Jordan
  20. In iodine-induced thyrotoxicosis, steroid therapy today could keep the surgical knife at bay
  21. Graves’ disease following allogenic hematopoietic stem cell transplantation for severe aplastic anemia: case report and literature review
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