From the Research
Thyroid storm can potentially lead to elevated lactic acid levels, though high lactic acid is not considered a primary symptom of thyroid storm itself. Thyroid storm is a life-threatening condition characterized by extreme hyperthyroidism with symptoms including high fever (often above 102°F), tachycardia (rapid heart rate exceeding 140 beats per minute), agitation, tremors, nausea, vomiting, diarrhea, and altered mental status. The hypermetabolic state during thyroid storm increases oxygen demand and can lead to tissue hypoxia, which may result in lactic acidosis as a secondary complication, as seen in a case report from 1. This occurs because the body's cells switch to anaerobic metabolism when oxygen supply is insufficient, producing lactic acid as a byproduct. Additionally, the increased adrenergic stimulation during thyroid storm can promote glycolysis and lactate production.
Key Considerations
- The presence of lactic acidosis in thyroid storm may indicate worsening of the condition and potentially affect management decisions regarding fluid resuscitation and supportive care, as highlighted in a study from 2.
- Clinicians should monitor for metabolic derangements including lactic acidosis when treating thyroid storm.
- The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood, but a heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones, as discussed in a review from 3.
- Treatment should be initiated promptly targeting all steps of thyroid hormone formation, release, and action, and patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy, as recommended in 3.
Clinical Implications
- Thyroid storm is a rare, life-threatening condition that requires emergency treatment, and its mortality is currently reported at 10%, as stated in 3.
- Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition, as emphasized in 3.
- The use of propranolol in treating thyroid storm should be done with caution, especially in patients with underlying thyrocardiac disease, as reported in a case study from 4.