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Thyroid Storm

Updated : February 6, 2024





Background

A thyroid storm sometimes referred to as a thyrotoxic crisis, is a severe, potentially fatal side effect of hyperthyroidism. It is a thyrotoxicosis presentation that has been exaggerated. It has an unexpected multisystem involvement.

Despite recent breakthroughs in the condition’s treatment and supporting measures, the death rate associated with thyroid storm is still believed to be between 8 and 25%. To lower mortality, it is crucial to identify it early and begin vigorous treatment. Thyroid storms can be identified clinically.

Epidemiology

It is an uncommon form of hyperthyroidism. About 1 percent to 2 percent of admissions for hyperthyroidism is due to thyroid storms. According to a survey conducted in the United States, there were 0.57 to 0.76 storm cases per 100,000 people in the general population, as well as 4.8 to 5.6 storm cases per 100,000 people who were hospitalized.

According to the Japanese National Survey, 5.4% of thyrotoxicosis patients who were hospitalized and 0.22 per 100,000 people annually experienced thyroid storm.

Similar to individuals with thyrotoxicosis without thyroid storm, those with thyroid storm had an average age of forty-two to forty-three years. Similar to thyrotoxicosis without storm group, the male-to-female ratio for the occurrence of thyroid storm was approximately 1:3.

Anatomy

Pathophysiology

It is unclear what pathophysiological factors cause thyroid storm to precipitate in thyrotoxicosis patients. To induce a thyroid storm, however, a precipitating trigger is always necessary, as was already explained. Numerous theories have been put forth.

According to one theory, the occurrence of a thyrotoxic crisis is caused by the sudden rise in levels of the hormone, which happens during surgical treatment, after radioiodine treatment, after abruptly stopping an antithyroid medication, or after giving large dosages of iodine during contrast research.

Other possible mechanisms for thyroid storm include the nervous system hyperactivity, which has a highly elevated response to catecholamine, as well as the body’s enhanced cell sensitivity to hormones under acute infections or stress, which causes the release of cytokines and modified immunological disruptions.

The majority of studies have not been able to correlate higher thyroid hormone levels as a cause of thyroid storm, with the exception of the research by Brooks and colleagues, which indicated increased free TSH among some of the patients with thyroid storm. In all other words, a higher incidence of thyroid storm is not exactly correlated with the level of thyroid hormone.

The clinical characteristics result from the thyroid hormone’s heightened actions. The body uses more oxygen because of intensive cell metabolism. The tachycardia that results from the need for more oxygen might cause cardiac failure and put the patient at risk for arrhythmias. Similar to these, agitation, delirium, seizures, and ultimate coma are CNS manifestations.

Etiology

Patients with confirmed or undiagnosed hyperthyroidism experience thyroid storms as a result of superimposed precipitating factors. Although it is more frequent in Graves’ disease, toxic multinodular goiter, and toxic thyroid adenoma are also possible causes of hyperthyroidism. These are the precipitating factors:

  • Abrupt antithyroid medication withdrawal
  • Thyroid operation
  • Other types of surgery
  • Trauma
  • Infections like Covid-19, cardiovascular accidents, abrupt myocardial infarction, diabetic ketoacidosis, heart failure, and adverse reactions are examples of acute diseases.
  • Use of iodinated media recently
  • Radioiodine treatment (rare)
  • Traumatic brain damage or stroke
  • Burns
  • Side effects of medications, such as anesthetics, amiodarone, and salicylates
  • Pregnancy hyperemesis gravidarum

Genetics

Prognostic Factors

Untreated thyroid storm is a serious medical issue that can be fatal. Cardiac arrest, arrhythmias, or the failure of numerous organs may all be the cause of death. However, most people who receive treatment experience improvement within a day. Poor prognosis risk factors include:

  • Mature age
  • Impairments in the brain at admission
  • Inability to use antithyroid drugs and beta-blockers
  • Hemodialysis and mechanical ventilator are required

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK448095/

Thyroid Storm

Updated : February 6, 2024




A thyroid storm sometimes referred to as a thyrotoxic crisis, is a severe, potentially fatal side effect of hyperthyroidism. It is a thyrotoxicosis presentation that has been exaggerated. It has an unexpected multisystem involvement.

Despite recent breakthroughs in the condition’s treatment and supporting measures, the death rate associated with thyroid storm is still believed to be between 8 and 25%. To lower mortality, it is crucial to identify it early and begin vigorous treatment. Thyroid storms can be identified clinically.

It is an uncommon form of hyperthyroidism. About 1 percent to 2 percent of admissions for hyperthyroidism is due to thyroid storms. According to a survey conducted in the United States, there were 0.57 to 0.76 storm cases per 100,000 people in the general population, as well as 4.8 to 5.6 storm cases per 100,000 people who were hospitalized.

According to the Japanese National Survey, 5.4% of thyrotoxicosis patients who were hospitalized and 0.22 per 100,000 people annually experienced thyroid storm.

Similar to individuals with thyrotoxicosis without thyroid storm, those with thyroid storm had an average age of forty-two to forty-three years. Similar to thyrotoxicosis without storm group, the male-to-female ratio for the occurrence of thyroid storm was approximately 1:3.

It is unclear what pathophysiological factors cause thyroid storm to precipitate in thyrotoxicosis patients. To induce a thyroid storm, however, a precipitating trigger is always necessary, as was already explained. Numerous theories have been put forth.

According to one theory, the occurrence of a thyrotoxic crisis is caused by the sudden rise in levels of the hormone, which happens during surgical treatment, after radioiodine treatment, after abruptly stopping an antithyroid medication, or after giving large dosages of iodine during contrast research.

Other possible mechanisms for thyroid storm include the nervous system hyperactivity, which has a highly elevated response to catecholamine, as well as the body’s enhanced cell sensitivity to hormones under acute infections or stress, which causes the release of cytokines and modified immunological disruptions.

The majority of studies have not been able to correlate higher thyroid hormone levels as a cause of thyroid storm, with the exception of the research by Brooks and colleagues, which indicated increased free TSH among some of the patients with thyroid storm. In all other words, a higher incidence of thyroid storm is not exactly correlated with the level of thyroid hormone.

The clinical characteristics result from the thyroid hormone’s heightened actions. The body uses more oxygen because of intensive cell metabolism. The tachycardia that results from the need for more oxygen might cause cardiac failure and put the patient at risk for arrhythmias. Similar to these, agitation, delirium, seizures, and ultimate coma are CNS manifestations.

Patients with confirmed or undiagnosed hyperthyroidism experience thyroid storms as a result of superimposed precipitating factors. Although it is more frequent in Graves’ disease, toxic multinodular goiter, and toxic thyroid adenoma are also possible causes of hyperthyroidism. These are the precipitating factors:

  • Abrupt antithyroid medication withdrawal
  • Thyroid operation
  • Other types of surgery
  • Trauma
  • Infections like Covid-19, cardiovascular accidents, abrupt myocardial infarction, diabetic ketoacidosis, heart failure, and adverse reactions are examples of acute diseases.
  • Use of iodinated media recently
  • Radioiodine treatment (rare)
  • Traumatic brain damage or stroke
  • Burns
  • Side effects of medications, such as anesthetics, amiodarone, and salicylates
  • Pregnancy hyperemesis gravidarum

Untreated thyroid storm is a serious medical issue that can be fatal. Cardiac arrest, arrhythmias, or the failure of numerous organs may all be the cause of death. However, most people who receive treatment experience improvement within a day. Poor prognosis risk factors include:

  • Mature age
  • Impairments in the brain at admission
  • Inability to use antithyroid drugs and beta-blockers
  • Hemodialysis and mechanical ventilator are required

https://www.ncbi.nlm.nih.gov/books/NBK448095/