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Posted On : 14 Jul 2015

A 12 yr old child presented with complaints of fever for 2 days, headache, irritability and 3 episodes of GTCS. No past history of similar or any other prolonged illness. On examination child was in E4V3M5 stage and irritable. Tone and DTR normal ,no signs of meningeal irritation, pupils NSNR. Child was having high grade fever, was underweight {25 kg}, b, l proptosis with a BP of 170, 120 mm hg. On CVS examination, 150 PR, normal vol peripheral pulses, there was hyperdynamic precordium with a grade 3 systolic murmur most prominent in left parasternal region not radiating to axilla or back. On investigations there was neutohilic leucocytosis, normal Hb, normal RFT, KFT, normal LFT, MP negative, widal To-1, 160, csf examination normal. CT scan showed small infarcts in various regions, normal thyroid studies, normal urine examination. Echocardiography revealed significant LV dysfunction with ejection fraction of 20 percent, no regurgitant murmur, no vegetations or valve thickening. Can somebody help in exact diagnosis_?

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Answer 1

The signs and symptoms described are consistent with the diagnosis of hyperthyroidism. Although, thyroid function test is normal, they can be a false finding. T4 levels may be normal if there is severe systemic illness as in this case or if there is T3 toxicosis. Also values may vary with the laboratory and their reference standards. Therefore repeat the thyroid function test. Also do a thyroid radioactive iodine uptake scan with I123. One may also do anti-TPO antibodies to look for Grave’s disease, as there is associated ophthalmopathy.

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