What is the mortality rate if patients with thyrotoxicosis (hyperthyroidism) are not diagnosed and treated promptly?

From the Guidelines

The mortality rate for untreated thyrotoxicosis is approximately 10-30%, with higher rates in elderly patients and those with significant comorbidities. Without prompt diagnosis and treatment, thyrotoxicosis can progress to thyroid storm, a life-threatening condition with mortality rates reaching 20-30% even with modern treatment 1. Mortality risk increases with age, presence of cardiovascular disease, and severity of hyperthyroidism. Key factors contributing to mortality include the development of atrial fibrillation, which is more frequent among patients over 60 years of age, and the potential for thromboembolism, although evidence suggests that embolic risk may not be increased independent of other stroke risk factors 1.

Key Considerations

• Early treatment typically involves antithyroid medications such as methimazole or propylthiouracil, along with beta-blockers like propranolol to control sympathetic symptoms.
• Supportive care and addressing the underlying cause are essential.
• The high mortality rate underscores the importance of prompt diagnosis through thyroid function tests and immediate initiation of appropriate therapy to prevent progression to more severe manifestations like thyroid storm, cardiac complications, or multiorgan failure.
• According to the 2014 AHA/ACC/HRS guideline, beta blockers are effective in controlling the ventricular rate in patients with thyrotoxicosis and AF, and treatment with beta blockers is particularly important in cases of thyroid storm 1.
• A study from 2016 highlights the importance of considering hyperthyroid cardiomyopathy in patients with hyperthyroidism, especially those with exertional dyspnea or other symptoms and signs of heart failure, emphasizing the need for prompt recognition and effective management of cardiac manifestations 1.

Management Approach

• Prompt diagnosis and treatment are crucial to prevent mortality and morbidity associated with untreated thyrotoxicosis.
• Treatment should be tailored to the individual patient, considering factors such as age, presence of comorbidities, and severity of hyperthyroidism.
• Regular monitoring and adjustment of treatment as necessary are vital to ensure optimal outcomes and minimize the risk of complications.

From the Research

Mortality Rate of Untreated Thyrotoxicosis

• The mortality rate for untreated thyrotoxicosis can be as high as 75% if therapy is delayed, as stated in the study 2.
• According to the study 3, the fatality rate for thyroid storm, a life-threatening complication of thyrotoxicosis, can range from 20% to 50%.
• Another study 2 reports an overall mortality rate of 10-20% for thyrotoxic crisis.
• The study 3 also mentions that the mortality rate was nearly 100% in the past, but has significantly decreased with improvements in early recognition and treatment.
• It is essential to note that prompt recognition and aggressive treatment are critical to reducing the mortality rate, as emphasized in the study 3.

Importance of Prompt Treatment

• Delaying therapy can significantly increase the mortality rate, as mentioned in the study 2.
• Early treatment, including medical therapy and thyroidectomy, can improve outcomes and reduce mortality, as discussed in the studies 2 and 4.
• The study 5 highlights the importance of managing thyroid storm, the most severe form of hyperthyroidism, with a stepwise approach and special attention to cardiac function.

Variability in Mortality Rates

• The mortality rates for untreated thyrotoxicosis and thyroid storm can vary depending on the population and the underlying cause of the condition, as suggested by the studies 2 and 3.
• The study 2 reports that thyrotoxic crisis is more common in women and the elderly, which may affect the mortality rate.
• The variability in mortality rates emphasizes the need for individualized treatment and prompt recognition of the condition, as discussed in the studies 2, 3, and 5.