From the Guidelines
Procalcitonin (PCT) is not a reliable marker for diagnosing thyroid storm, as it can be elevated in both thyroid storm and sepsis, creating potential diagnostic confusion. While PCT is primarily used as a biomarker for bacterial infections and sepsis, thyroid storm can also cause PCT elevation through inflammatory mechanisms, even in the absence of infection 1. When evaluating a patient with suspected thyroid storm, clinicians should rely on established clinical criteria such as the Burch-Wartofsky Point Scale or Japan Thyroid Association criteria, which assess fever, tachycardia, CNS effects, gastrointestinal symptoms, and precipitating events.
Key Considerations
- Laboratory confirmation should include thyroid function tests (elevated free T3, free T4, suppressed TSH) rather than PCT.
- Treatment of thyroid storm requires immediate intervention with a multi-targeted approach:
- beta-blockers (propranolol 60-80 mg every 4-6 hours) to control sympathetic symptoms
- thionamides (methimazole 20-25 mg every 6 hours or propylthiouracil 200-250 mg every 4 hours) to block new hormone synthesis
- iodine solutions (SSKI 5 drops every 6 hours, started 1 hour after thionamides) to block hormone release
- glucocorticoids (hydrocortisone 100 mg every 8 hours) to treat potential adrenal insufficiency
- supportive care If infection is also suspected, appropriate cultures should be obtained and empiric antibiotics initiated while monitoring both thyroid function and infection markers 1.
From the Research
Procalcitonin and Thyroid Storm
- There is no direct mention of procalcitonin in the provided studies 2, 3, 4
- The studies focus on the management and diagnosis of thyroid storm, a life-threatening condition that requires prompt medical attention 2, 3, 4
- Thyroid storm is characterized by a combination of thyroid function studies and clinical signs and symptoms of end-organ damage, including hyperpyrexia, tachyarrhythmias, and congestive heart failure 3, 4
- Treatment involves bridging to a euthyroid state prior to definitive therapy, such as total thyroidectomy or radioactive iodine ablation, and may include pharmacological options like anti-thyroid medications, beta blockers, and glucocorticoids 3, 4
- Management of thyroid storm in pregnancy poses unique challenges and requires specialist consultation and adapted treatment options to prevent fetal and maternal complications 4