From the Guidelines
Thyroid storm is a life-threatening 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 (nervousness, restlessness, confusion, seizures), vomiting, diarrhea, and cardiac arrhythmia, as noted in the study by 1.
Key Symptoms
- Fever
- Tachycardia
- Altered mental status (nervousness, restlessness, confusion, seizures)
- Vomiting
- Diarrhea
- Cardiac arrhythmia These symptoms can lead to severe complications, including shock, stupor, and coma if left untreated, highlighting the importance of prompt recognition and treatment, as indicated by the high risk of maternal heart failure mentioned in the study by 1.
Diagnosis and Treatment
Diagnosis is based on a combination of clinical presentation and laboratory tests, including serum-free triiodothyronine (FT3), FT4, and TSH levels, although treatment should not be delayed for test results, as emphasized in the study by 1. Treatment involves a standard series of drugs, including propylthiouracil or methimazole, saturated solution of potassium iodide or sodium iodide, dexamethasone, and phenobarbital, along with general supportive measures, such as oxygen, antipyretics, and appropriate monitoring, as outlined in the study by 1.
From the Research
Symptoms of Thyroid Storm
The symptoms of thyroid storm, also known as hyperthyroid crisis, include:
- Hyperpyrexia (high fever) 2, 3
- Hypotension (low blood pressure) 2
- Cardiac arrhythmias (irregular heartbeats) 2, 3
- Tachycardia (rapid heart rate) 3
- Signs of congestive heart failure 3
- Vomiting and diarrhea 3
- Hepatic dysfunction (liver problems) 3
- Central nervous system disturbance (problems with the brain and nervous system) 3
- Death (in severe cases) 2, 4
Clinical Features
Thyroid storm is characterized by exaggerated signs and symptoms of thyrotoxicosis and evidence of multiorgan decompensation, usually occurring in the presence of an inciting trigger 3. The clinical features of thyroid storm may include:
- Fever 3
- Tachycardia 3
- Signs of congestive heart failure 3
- Vomiting and diarrhea 3
- Hepatic dysfunction 3
- Central nervous system disturbance 3
Diagnosis and Treatment
The diagnosis of thyroid storm is challenging and requires consideration of the disease, as well as laboratory assessment and clinical criteria such as the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria 3, 4. Treatment focuses on diagnosing and managing the trigger, resuscitation, administration of steroids, thionamides, iodine, and cholestyramine, and treatment of hyperthermia and agitation 3, 4. Beta blockers should be administered in the absence of severe heart failure 3, 5.