Thyroid storm

Editor-In-Chief: Prab R Tumpati, MD
Obesity, Sleep & Internal medicine
Founder, WikiMD Wellnesspedia &
W8MD medical weight loss NYC and sleep center NYC

Thyroid storm
Synonyms	Thyrotoxic crisis
Pronounce	N/A
Specialty	N/A
Symptoms	Fever, tachycardia, hypertension, confusion, diarrhea, vomiting
Complications	Heart failure, arrhythmia, coma
Onset	Sudden
Duration	Variable
Types	N/A
Causes	Hyperthyroidism, Graves' disease, toxic multinodular goiter
Risks	Infection, surgery, trauma, pregnancy
Diagnosis	Clinical evaluation, thyroid function tests
Differential diagnosis	Sepsis, pheochromocytoma, malignant hyperthermia
Prevention	N/A
Treatment	Beta blockers, antithyroid drugs, corticosteroids, supportive care
Medication	Propranolol, methimazole, propylthiouracil
Prognosis	Potentially life-threatening without treatment
Frequency	Rare
Deaths	High mortality if untreated

Thyroid storm, also known as thyrotoxic crisis, is a rare but life-threatening condition characterized by an extreme overproduction of thyroid hormones. It is a severe form of hyperthyroidism and requires immediate medical attention.

Pathophysiology

Thyroid storm occurs when there is a sudden and excessive release of thyroid hormones, leading to a hypermetabolic state. This can result from untreated or inadequately treated Graves' disease, toxic multinodular goiter, or thyroiditis. The excessive thyroid hormones increase the body's metabolism, affecting multiple organ systems.

Symptoms

The symptoms of thyroid storm are severe and can include:

• High fever
• Tachycardia (rapid heart rate)
• Hypertension (high blood pressure)
• Arrhythmias
• Heart failure
• Delirium or psychosis
• Nausea, vomiting, and diarrhea
• Jaundice

Diagnosis

Diagnosis of thyroid storm is primarily clinical, based on the presence of symptoms and a history of hyperthyroidism. Laboratory tests may show elevated levels of triiodothyronine (T3) and thyroxine (T4), with suppressed thyroid-stimulating hormone (TSH).

Treatment

Treatment of thyroid storm involves:

• Antithyroid medications: Such as propylthiouracil or methimazole to reduce thyroid hormone production.
• Beta-blockers: To control symptoms like tachycardia and hypertension.
• Corticosteroids: To reduce inflammation and inhibit peripheral conversion of T4 to T3.
• Supportive care: Including intravenous fluids, oxygen therapy, and cooling blankets to manage fever.

Prognosis

With prompt and appropriate treatment, the prognosis for thyroid storm can be good. However, if left untreated, it can lead to severe complications such as heart failure, shock, and death.

Prevention

Preventing thyroid storm involves proper management of underlying hyperthyroidism. Regular monitoring and adherence to prescribed treatments can help prevent the occurrence of a thyroid storm.

See Also

• Hyperthyroidism
• Graves' disease
• Thyroid gland
• Endocrinology