Thyroid storm

Thyroid storm
Other namesThyrotoxic crisis
SpecialtyEndocrinology Edit this on Wikidata
Differential diagnosisSepsis, infectious disease[1]
Prognosis8-25% mortality with treatment; 80-100% mortality if untreated

Thyroid storm is a rare but severe and life-threatening complication of hyperthyroidism. It occurs when an overactive thyroid leads to hypermetabolism, which can cause death from cardiac arrest or multiple organ failure.[2]

It is characterized by a high fever (temperatures often above 40 °C / 104 °F), fast and often irregular heart beat, elevated blood pressure, vomiting, diarrhea, and agitation. Hypertension with a wide pulse pressure occurs in early to mid crisis, with hypotension accompanying shock occurring in the late stage.[3] Heart failure and heart attack may occur. Death may occur despite treatment.[4] Most episodes occur either in those with known hyperthyroidism whose treatment has stopped or become ineffective, or in those with untreated mild hyperthyroidism who have developed an intercurrent illness (such as an infection).[4]

The primary treatment of thyroid storm is with inorganic iodine and antithyroid drugs (propylthiouracil or methimazole) to reduce synthesis and release of thyroid hormone. Temperature control and intravenous fluids are also mainstays of management. Beta blockers are often used to reduce the effects of thyroid hormone.[5] Patients often require admission to the intensive care unit.[6]

As a life-threatening medical emergency, thyroid storm has a mortality rate of up to 25% despite treatment.[1][7] Without treatment, the condition is typically fatal, with a mortality rate of 80-100%.[8] Historically, the condition was considered untreatable, with hospital mortality rates approaching 100%.[9][10]

  1. ^ a b Pokhrel B, Aiman W, Bhusal K (2022-10-06). "Thyroid Storm". StatPearls Publishing. PMID 28846289. Retrieved 2023-05-28.
  2. ^ Nai Q, Ansari M, Pak S, Tian Y, Amzad-Hossain M, Zhang Y, Lou Y, Sen S, Islam M (2018). "Cardiorespiratory Failure in Thyroid Storm: Case Report and Literature Review". Journal of Clinical Medicine Research. 10 (4). Elmer Press, Inc.: 351–357. doi:10.14740/jocmr3106w. ISSN 1918-3003. PMC 5827921. PMID 29511425.
  3. ^ "Thyroid Storm Clinical Presentation: History, Physical Examination, Complications".
  4. ^ a b Klubo-Gwiezdzinska J, Wartofsky, Leonard (March 2012). "Thyroid emergencies". Medical Clinics of North America. 96 (2): 385–403. doi:10.1016/j.mcna.2012.01.015. PMID 22443982.
  5. ^ Cite error: The named reference Chiha was invoked but never defined (see the help page).
  6. ^ Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (June 2011). "Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists". Thyroid. 21 (6): 593–646. doi:10.1089/thy.2010.0417. PMID 21510801.
  7. ^ Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y (2016). "Factors Associated With Mortality of Thyroid Storm". Medicine. 95 (7). Ovid Technologies (Wolters Kluwer Health): e2848. doi:10.1097/md.0000000000002848. ISSN 0025-7974. PMC 4998648. PMID 26886648.
  8. ^ Idrose AM (2015-05-12). "Acute and emergency care for thyrotoxicosis and thyroid storm". Acute Medicine & Surgery. 2 (3). Wiley: 147–157. doi:10.1002/ams2.104. ISSN 2052-8817. PMC 5667251. PMID 29123713.
  9. ^ "Gathering Storm: Treating the Once Fatal Thyroid Storm". Endocrine News. 2014-08-01. Retrieved 2023-05-28.
  10. ^ Misra M (2023-02-02). "Thyroid Storm: Practice Essentials, Pathophysiology, Etiology". Medscape Reference. Retrieved 2023-05-28.