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Description

Thyroid storm is a rare, life-threatening endocrine emergency representing the most severe form of thyrotoxicosis, with mortality reported up to 10-30%. Pediatric thyroid storm is exceedingly uncommon and diagnostically challenging, particularly when presentation overlaps with toxicologic syndromes. This case describes a 15-year-old female whose initial presentation suggested sertraline overdose and serotonin syndrome, but whose course ultimately revealed thyroid storm.

A 15-year-old female with autism, depression, and ADHD presented after ingestion of 125 mg of sertraline, with tachycardia, tachypnea, hypertension, and hallucinations, and was treated for presumed serotonin syndrome with benzodiazepines. Despite largely unremarkable initial laboratory studies and sinus tachycardia on ECG, she remained hemodynamically unstable. In the PICU, she was diaphoretic, tachycardic, tachypneic, afebrile, with decreased GCS and an enlarged thyroid, and detailed history revealed six months of diarrhea, heat intolerance, weight loss, and unexplained tachycardia with family history of autoimmunity.

Thyroid storm should remain on the differential for pediatric patients with unexplained tachycardia, altered mental status, and gastrointestinal symptoms, even when an apparent toxic ingestion is reported. Careful history and physical examination, particularly evaluation for chronic hyperthyroid symptoms and goiter, were pivotal in correcting the initial misdiagnosis in this case. Early endocrinology involvement and prompt institution of guideline-consistent multimodal therapy can lead to rapid stabilization and improved outcomes in pediatric thyroid storm.

Publication Date

5-8-2026

Disciplines

Emergency Medicine

Comments

2026 Research Day Corewell Health West, Grand Rapids, MI, May 8, 2026. Abstract 1948

Thyroid Storm Masquerading as Serotonin Syndrome: A Pediatric Case Report

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