Thyroid storm

Definition

Thyroid storm is a very rare, but life-threatening condition of the thyroid gland that develops in cases of untreated thyrotoxicosis (hyperthyroidism, or overactive thyroid).

The thyroid gland is located in the neck, just above where your collarbones meet in the middle.

Alternative Names

Thyrotoxic storm; Thyrotoxic crisis; Hyperthyroid storm; Accelerated hyperthyroidism; Thyroid crisis; Thyrotoxicosis - thyroid storm

Causes

Thyroid storm occurs due to a major stress such as trauma, heart attack, or infection in people with uncontrolled hyperthyroidism. In rare cases, thyroid storm can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease. This can occur even a week or more after the radioactive iodine treatment.

Symptoms

Symptoms are severe and may include any of the following:

• Agitation
• Change in alertness (consciousness)
• Confusion
• Diarrhea
• Increased temperature
• Pounding heart (tachycardia)
• Restlessness
• Shaking
• Sweating
• Bulging eyeballs

Exams and Tests

The health care provider may suspect thyrotoxic storm based on:

• A high systolic (top number) blood pressure reading with a lower diastolic (bottom number) blood pressure reading (wide pulse pressure)
• A very high heart rate
• A history of hyperthyroidism
• An exam of your neck may find that your thyroid gland is enlarged (goiter)

Blood tests are done to check thyroid hormones TSH, free T4 and T3.

Other blood tests are done to check heart and kidney functions and to check for infection.

Treatment

Thyroid storm is life-threatening and requires emergency treatment. Often, the person needs to be admitted to the intensive care unit. Treatment includes supportive measures, such as giving oxygen and fluids in case of breathing difficulty or dehydration. Treatment may include:

• Cooling blankets to return the body temperature to normal
• Monitoring any excess fluid in older people with heart or kidney disease
• Medicines to manage agitation
• Medicine to slow the heart rate
• Vitamins and glucose

The final goal of treatment is to decrease the levels of thyroid hormones in the blood. Sometimes, iodine is given in high doses to try and stun the thyroid. Other drugs may be given to lower the hormone level in the blood. Beta blocker medicines are often given by vein (IV) to slow the heart rate, lower blood pressure, and block the effects of the thyroid hormone excess.

Antibiotics are given in case of infection.

Possible Complications

Irregular heart rhythms (arrhythmias) may occur. Heart failure and pulmonary edema can develop rapidly and cause death.

When to Contact a Medical Professional

This is an emergency condition. Call 911 or another emergency number if you have hyperthyroidism and experience symptoms of thyroid storm.

Prevention

To prevent thyroid storm, hyperthyroidism should be treated.

Images

References

Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.

Marino M, Vitti P, Chiovato L. Graves' disease. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 82.

Tallini G, Giordano TJ. Thyroid gland. In: Goldblum JR, Lamps LW, McKenney JK, Myers JL, eds. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia, PA: Elsevier; 2018:chap 8.

Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 120.