Table 3.
Hospital Admissions Prior to the Diagnosis of Graves Disease
| Hospital Encounter | Presentation | Diagnostic Detours | Time in Hospital Before Thyroid Testing | Duration of Hospital Stay (Days) |
|---|---|---|---|---|
| Hospital ward | 11-year-old female with tachycardia | Admitted to Pediatric Cardiology service. ECG and telemetry were obtained. Thyroid functions had been drawn shortly prior to hospitalization, and on discovery of these results, Pediatric Endocrinology was consulted. | Thyroid studies obtained before admission | 2 |
| Hospital ward | 13-year-old female with abdominal pain, diarrhea, weight loss, and malnutrition | Admitted to Pediatric Gastroenterology service. Tests performed included ECG, abdominal radiograph and CT, esophagogastroduodenoscopy, stool studies, and central venous line placement for total parenteral nutrition. Antibiotics were started for presumed Helicobacter pylori infection. | 6 days—tests drawn because of persistent tachycardia | 9 |
| Hospital ward | 15-year-old female with hyperventilation and tachycardia | Presented to ER and treated with alprazolam with resolution of tachypnea. Tests included routine chemistries,a urine studies, lipase, creatine phosphokinase, and ECG. Tachycardia treated overnight with intravenous fluids. | 1 day—tests drawn because of persistent tachycardia and diaphoresis | 3 |
| ICU/ward | 4-year-old female with status epilepticus | Presented to ER via ambulance after receiving rectal valium, lorazepam, and fosphenytoin for prolonged seizure. Intubation was required because of apnea. On admission, routine chemistries,a blood gas, urine studies, and blood and urine cultures were obtained. Cardiology consulted for hypertension. Imaging studies included a chest radiograph, renal ultrasound, echocardiogram, and head CT. Initially started on phenytoin for seizures and captopril and propranolol for hypertension and tachycardia. | Obtained on the day of admission to the hospital | 6 |
| ICU/ward | 9-year-old female with emesis and dehydration | Seen by primary care physician for 1 month because of weight loss. Admitted to ICU from outside hospital after 2 days of severe vomiting and dehydration. Routine chemistriesa and blood and urine cultures obtained, with results of previous thyroid testing subsequently discovered. | Thyroid studies obtained shortly before admission | 3 |
| ICU/ward | 17-year-old female with difficulty walking and paresthesias | Seen by primary care physician and then sent to ER and admitted to ICU. Initial tests included hemoglobin A1c, rapid strep test, routine chemistries, urine studies, ECG, and chest radiograph. | Obtained on the day of admission to the hospital | 5 |
Abbreviations: ECG, electrocardiogram; CT, computed tomography; ER, emergency room; ICU, intensive care unit. a Routine chemistries include complete blood count and comprehensive metabolic profile.