From the Guidelines
Thyroid storm is a life-threatening medical emergency characterized by extreme symptoms of hyperthyroidism, including high fever, rapid heart rate, agitation, confusion, and seizures, which can lead to heart failure, coma, and death if not promptly treated. The main symptoms of thyroid storm include 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. Patients may also experience severe nausea, vomiting, diarrhea, abdominal pain, and profound weakness, as well as tremors, restlessness, and extreme anxiety. Some patients develop congestive heart failure with shortness of breath and swelling in the legs, and jaundice may occur due to liver dysfunction.
The symptoms of thyroid storm can be summarized as follows:
- High fever (often above 102°F/38.9°C)
- Rapid heart rate (tachycardia) exceeding 140 beats per minute
- High blood pressure
- Irregular heartbeat
- Extreme agitation, confusion, delirium, psychosis, seizures, and even coma
- Severe nausea, vomiting, diarrhea, abdominal pain, and profound weakness
- Tremors, restlessness, and extreme anxiety
- Congestive heart failure with shortness of breath and swelling in the legs
- Jaundice due to liver dysfunction
According to the most recent study by 1, beta-blockers, such as propranolol, can be used to control heart rate and tremors in patients with thyrotoxicosis or symptomatic hyperthyroidism. However, the primary study guiding the diagnosis and treatment of thyroid storm remains the 2002 study by 1, which emphasizes the importance of prompt treatment with medications to block thyroid hormone production, beta-blockers, corticosteroids, and supportive care. Without prompt treatment, thyroid storm can lead to heart failure, coma, and death, with mortality rates of 10-30% even with treatment.
From the Research
Symptoms of Thyroid Storm
The symptoms of thyroid storm, also known as thyrotoxic crisis, include:
- Fever 2, 3
- Tachycardia 2, 3, 4, 5
- Signs of congestive heart failure 2
- Vomiting/diarrhea 2
- Hepatic dysfunction 2
- Central nervous system disturbance 2, 3, 5
- Hyperthermia 3, 4, 5
- Altered mental state with severe agitation 3
- Myasthenia 5
- Cardiovascular symptoms 5
Clinical Features and Diagnosis
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 2. The diagnosis is made based on clinical criteria, such as the Burch-Wartofsky point scale and Japan Thyroid Association diagnostic criteria 2, as thyroid hormone measurements do not differentiate between thyroid storm and uncomplicated hyperthyroidism 3, 5.
Precipitating Factors
Thyroid storm can be precipitated by various factors, including: