case_images: PMC7170342_01
case_images: T4 (mcg/dl), Free T4 (ng/dl), T3 (ng/ml), and TSH (mU/L) levels after starting treatment with anti-thyroid medications and after thyroidectomy
case_images: IJCIIS-10-38-g001.jpg
case_images: PMC7170342_01_IJCIIS-10-38-g001.jpg
case_images: F1
case_images: Levels of thyroid-stimulating hormone (TSH) were 0.02 mIU/L (0.5-5.5 mIU/L) with elevated thyroid hormones - total T4 level of > 24.9 mcg/dl (5.9-13.2 mcg/dL) and free T4 level of 7 ng/dl (1.0-1.6 ng/dL) [Figure 1]. A small decrease in thyroid hormone levels were noted, as shown in Figure 1.
case_images: Average daily systolic and diastolic blood pressures, anti-hypertensive medication used as well as daily Glasgow Coma Scale and Delirium Scales during the pediatric intensive care unit stay
case_images: IJCIIS-10-38-g002.jpg
case_images: PMC7170342_01_IJCIIS-10-38-g002.jpg
case_images: F2
case_images: Due to persistent refractory hypertension, sodium nitroprusside was the second IV infusion added on D4 of PICU stay and escalated to a moderately high dosing of 4 mcg/kg/min that allowed Nicardipine to be weaned to 2 mcg/kg/min [Figure 2] On day 7 of hospitalization, the patient developed atrial flutter needing synchronized cardioversion. By day 12 of her hospitalization, despite aggressive medical management, the patient continued to have refractory hypertension [Figure 2]. A dexmedetomidine infusion and intermittent haloperidol were provided for symptomatic relief, but by day 4 of hospitalization, the patient became obtunded with the loss of protective airway reflexes, necessitating tracheal intubation and mechanical ventilation [Figure 2].