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Thyroid Storm

A life-threatening hyperthyroid crisis caused by excessive thyroid hormone release.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Endokrinoloji department. Book Appointment →

What is Thyroid Storm?

Thyroid storm (thyroid crisis) is an acute, life-threatening exacerbation of uncontrolled or untreated hyperthyroidism triggered by a precipitating factor. Mortality is 10-30%, and management in an intensive care unit is required.

The most common triggers are infection, surgery, thyroid surgery, recent radioactive iodine treatment, trauma, childbirth, and abrupt withdrawal of thyroid hormone medications. Graves' disease and toxic nodular goiter are the main underlying causes.

The Burch-Wartofsky scoring system supports diagnosis. Pathophysiology is based on accelerated peripheral T4-to-T3 conversion, increased catecholamine sensitivity, and impaired thermoregulation.

Symptoms

High fever (>38.5°C, sometimes >40°C)
Rapid and irregular heartbeat (tachycardia, atrial fibrillation)
Severe sweating and heat intolerance
Agitation, confusion, and altered consciousness
Vomiting, diarrhea, and abdominal pain
Signs of heart failure (shortness of breath, edema)

Risk Factors

Untreated or poorly controlled hyperthyroidism
Infection, surgery, or trauma
Thyroid surgery or radioactive iodine therapy
Use of iodinated contrast media
Discontinuation of thyroid hormone medications

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Onset of high fever and rapid heartbeat in a known hyperthyroid patient (EMERGENCY!)
  • Confusion, agitation, or altered consciousness
  • Such a presentation following an infection or stress in untreated hyperthyroidism

Treatment Methods

01
Mandatory intensive care unit monitoring
02
Thionamides (loading dose of propylthiouracil): rapidly suppress thyroid hormone synthesis
03
Iodide (Lugol's solution): given 1 hour after thionamide — blocks hormone release
04
Propranolol IV or PO: heart rate control and reduction of peripheral T4-to-T3 conversion
05
Corticosteroids (hydrocortisone or dexamethasone): adrenal insufficiency support and T4-to-T3 inhibition
06
Fever control: paracetamol (aspirin not recommended as it disrupts T4-TBG binding)
07
Treatment of the precipitating cause (antibiotics, etc.)

Which Department to Visit?

You can visit our Endokrinoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.