From the Research
Management of Thyroid Storm
The management of thyroid storm, also known as hyperthyroid crisis, involves a multifaceted approach to correct the life-threatening condition. The key components of management include:
- Blocking the synthesis of thyroid hormones with antithyroid drugs such as methimazole (MMI) or propylthiouracil (PTU) 1, 2, 3
- Blocking the release of preformed hormone with iodine 2
- Meticulous attention to hydration and supportive therapy 2, 3
- Correction of the precipitating cause of the storm 2
- Use of therapeutic plasma exchange (TPE) in patients who cannot tolerate or fail pharmacotherapy, or are not suitable for thyroidectomy 1, 4
- Use of steroid pulse to control associated systemic inflammatory reactions 3
Treatment Options
Treatment options for thyroid storm include:
- Antithyroid agents such as MMI or PTU to block the production of thyroid hormones 1, 3
- TPE to remove T3 and T4 bound to albumin, autoantibodies, catecholamines, and cytokines 1
- Thyroidectomy as a definitive treatment for hyperthyroidism 1, 4
- Supportive intensive care measures to manage organ decompensation and haemodynamic collapse 3
Mortality and Recurrence
The mortality rate of thyroid storm is reported to be up to 30% if left untreated 1, and currently around 10% with prompt treatment 4. Patients who survive thyroid storm should receive definitive therapy for their underlying hyperthyroidism to avoid recurrence of the condition 4.