From the Guidelines
Thyroid storm is a life-threatening medical emergency characterized by extreme symptoms of hyperthyroidism, including fever, tachycardia, altered mental status, vomiting, diarrhea, and cardiac arrhythmia. The symptoms of a thyroid storm, also known as hyperthyroid crisis, can be identified based on a combination of signs and symptoms, such as:
- Fever
- Tachycardia out of proportion to the fever
- Altered mental status, including nervousness, restlessness, confusion, and seizures
- Vomiting and diarrhea
- Cardiac arrhythmia These symptoms can lead to severe complications, including shock, stupor, and coma, if left untreated 1.
The diagnosis of thyroid storm is based on clinical presentation, and treatment should not be delayed for test results, including serum-free triiodothyronine (FT3), FT4, and TSH levels 1. A standard series of drugs is used to treat thyroid storm, including propylthiouracil or methimazole, saturated solution of potassium iodide or sodium iodide, dexamethasone, and phenobarbital, in addition to general supportive measures such as oxygen, antipyretics, and appropriate monitoring 1.
It is essential to identify and treat the underlying cause of thyroid storm, and fetal status should be evaluated in pregnant women, depending on gestational age, with ultrasound examination, nonstress testing, or a biophysical profile 1. Early recognition and aggressive treatment of thyroid storm are crucial to prevent severe complications and reduce mortality rates.
From the Research
Symptoms of Thyroid Storm
The symptoms of thyroid storm, also known as hyperthyroid crisis, include:
- Hyperthermia 2, 3, 4
- Tachycardia 2, 3, 5, 4
- Respiratory distress 2
- Gastrointestinal and hepatic symptoms 2
- Central nervous system dysfunction 2, 3
- Fever 3
- Signs of congestive heart failure 3
- Vomiting/diarrhea 3
- Hepatic dysfunction 3
- Central nervous system disturbance 3
Clinical Features and Diagnosis
Thyroid storm is a clinical diagnosis characterized by exaggerated signs and symptoms of thyrotoxicosis and evidence of multiorgan decompensation, usually occurring in the presence of an inciting trigger 3. The diagnosis is made entirely on clinical findings, and any delay in therapy should be avoided 4. Clinical criteria, such as the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria, can aid in diagnosis 3.
Treatment and Management
Treatment for thyroid storm focuses on diagnosing and managing the trigger, resuscitation, administration of steroids, thionamides, iodine, and cholestyramine, and treatment of hyperthermia and agitation 3. Beta blockers should be administered in the absence of severe heart failure 3, 5. In extreme circumstances, treatment considerations include plasmapheresis and thyroidectomy 6, 5, 4.