From the Guidelines
Thyroid storm is diagnosed based on a combination of signs and symptoms, including fever, tachycardia, altered mental status, vomiting, diarrhea, and cardiac arrhythmia, as well as serum-free triiodothyronine (FT3), FT4, and TSH levels. The diagnosis of thyroid storm requires a high index of suspicion, as there is no single diagnostic test 1. Patients typically present with a range of symptoms, including:
- Fever
- Tachycardia out of proportion to the fever
- Altered mental status (nervousness, restlessness, confusion, seizures)
- Vomiting
- Diarrhea
- Cardiac arrhythmia These symptoms can be triggered by an inciting event, such as surgery, infection, labor, or delivery 1. Laboratory tests, including serum-free triiodothyronine (FT3), FT4, and TSH levels, can help confirm the diagnosis, but treatment should not be delayed for test results 1. It is essential to initiate treatment immediately, as thyroid storm is a medical emergency with a high risk of maternal heart failure and mortality 1.
From the Research
Diagnostic Criteria for Thyroid Storm
The diagnostic criteria for thyroid storm, also known as hyperthyroidism crisis, are primarily clinical and based on the presence of life-threatening multisystemic organ involvement in the setting of uncontrolled hyperthyroidism 2, 3, 4. The diagnosis is often made based on the patient's symptoms and physical examination findings, as there are no specific laboratory abnormalities that are diagnostic of thyroid storm 3, 4.
Clinical Presentation
Patients with thyroid storm typically exhibit exaggerated signs and symptoms of hyperthyroidism, including:
Scoring Systems
Several scoring systems have been developed to aid in the diagnosis of thyroid storm, including the Burch-Wartofsky Point Scale and the Japanese Thyroid Association criteria 6. However, these systems have limitations, including a lack of sensitivity in identifying milder cases of thyroid storm and a reliance on subjective clinical judgment 6.
Key Features
The key features of thyroid storm include:
- A life-threatening illness in a hyperthyroid patient
- Severe exacerbation of hyperthyroidism by a serious precipitating illness
- Symptoms of hyperpyrexia, tachycardia, and alterations in consciousness
- Multi-organ dysfunction
- No specific laboratory abnormalities that are diagnostic of thyroid storm 2, 5, 3, 4