Myxedema crisis and ovarian hyperstimulation in a child with Down syndrome.

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.

• Authors: Maria Susan Abraham, Geethalakshmi Sampathkumar, Rajeshwari Narayanan, Prahada Jagannathan
• Journal: Journal of pediatric endocrinology & metabolism : JPEM (J Pediatr Endocrinol Metab) Vol. 35 Issue 2 Pg. 267-271 (Feb 23 2022) ISSN: 2191-0251 [Electronic] Germany
• PMID: 34547195 (Publication Type: Case Reports)
• Copyright: © 2021 Walter de Gruyter GmbH, Berlin/Boston.

Chemical References

• Triiodothyronine
• Thyroxine

Topics

• Adolescent
• Down Syndrome (complications)
• Female
• Humans
• Hypothyroidism (complications)
• Myxedema (drug therapy, etiology)
• Ovarian Hyperstimulation Syndrome (etiology)
• Thyroxine (administration & dosage)
• Triiodothyronine (administration & dosage)