An 11-year-old Hispanic girl presented to the Emergency Depa…
An 11-year-old Hispanic girl presented to the Emergency Department with a one-day history of respiratory distress, fever, and dysphagia that developed after several days of upper respiratory infection symptoms and sore throat. PMH is significant for prematurity (26 weeks gestational age), associated with chronic lung disease. On examination, patient is noted to be moderately agitated. T: 101.4ºF, HR: 200/min, RR: 40/min; O2 sat (room air): 91%, BP: 164/92. She had diffuse erythema of the pharynx, exophthalmos, and a diffuse bilateral goiter. There were no palpable thyroid nodules or tenderness, but a thyroid bruit was present. On her lung exam she had bilateral wheezes. Diagnostic tests/Laboratory test results: Nasal swab (+) respiratory syncytial virus (RSV); CXR: suggestive of viral pneumonia; (+) serum anti-thyroid antibodies. Labs (with normal ranges) At diagnosis TSH (0.37–4.42mIU/L) 0.01 Free T4 (0.65–1.80ng/dl) 8.17 Free T3 (335– 480pg/dl) 1918 Based on this information, which of the following conditions is the most likely diagnosis for this patient?
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