The information on this website is not intended for diagnosis or treatment. Please consult your physician for health concerns.

+90 850 321 50 00

Thyrotoxic Crisis — Thyroid Storm

Life-threatening exacerbation of hyperthyroidism with extreme hyperthermia, tachyarrhythmias and multi-organ dysfunction.

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 Acil Servis department. Book Appointment →

What is Thyrotoxic Crisis — Thyroid Storm?

Thyrotoxic crisis or thyroid storm is a rare but life-threatening exacerbation of thyrotoxicosis characterized by extreme thermoregulatory, cardiovascular, gastrointestinal and central nervous system dysfunction, with mortality of 10 to 30 percent if untreated.

Common precipitants include withdrawal of antithyroid drugs, infection, surgery, trauma, pregnancy, parturition, diabetic ketoacidosis, iodine load (contrast media, amiodarone) and radioactive iodine therapy in poorly controlled Graves disease.

Clinical features encompass hyperpyrexia greater than 38.5 degrees, sinus tachycardia or atrial fibrillation with rapid response, congestive heart failure, agitation, delirium, seizures, vomiting, diarrhea and hepatic dysfunction with jaundice.

Diagnosis is clinical (Burch and Wartofsky score or Japan Thyroid Association criteria) supported by laboratory evidence of suppressed thyroid stimulating hormone with elevated free thyroid hormones; treatment must not await biochemical confirmation.

Management combines beta blockade (propranolol or esmolol), thionamides (propylthiouracil preferred initially), iodine solutions one hour after thionamide, glucocorticoids (hydrocortisone), aggressive cooling, fluid resuscitation, treatment of precipitant and intensive care monitoring.

Symptoms

Hyperpyrexia greater than 38.5 degrees
Sinus tachycardia greater than 130 beats per minute or atrial fibrillation
Congestive heart failure with peripheral edema
Agitation, delirium or coma
Tremor and hyperreflexia
Vomiting, diarrhea and abdominal pain
Jaundice and hepatic dysfunction
Hypotension in advanced shock
Seizures in severe central nervous system involvement

Risk Factors

Untreated or poorly controlled Graves disease
Toxic multinodular goiter or toxic adenoma
Recent withdrawal of antithyroid drugs
Infection, sepsis or surgical stress
Pregnancy, labor or postpartum period
Iodinated contrast administration or amiodarone exposure
Recent thyroid or non-thyroid surgery
Diabetic ketoacidosis or trauma

When to See a Doctor?

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

  • High fever with rapid irregular pulse on thyroid medication
  • Confusion or agitation in patient with hyperthyroidism
  • Heart failure symptoms with weight loss and tremor
  • Vomiting and diarrhea with palpitations and goitre
  • Recent antithyroid drug discontinuation with deterioration

Treatment Methods

01
Propranolol intravenously (1 mg slow) or oral 60 to 80 mg every 4 hours; esmolol if heart failure
02
Propylthiouracil 500 to 1000 mg loading then 250 mg every 4 hours (preferred over methimazole initially)
03
Iodine solution (Lugol or saturated solution of potassium iodide) one hour after first thionamide dose
04
Hydrocortisone 100 mg intravenously every 8 hours
05
Aggressive cooling with cold packs, sponges and acetaminophen (avoid aspirin)
06
Intravenous fluid resuscitation and electrolyte correction
07
Identification and treatment of precipitating factor
08
Intensive care unit monitoring with cardiac telemetry
09
Plasmapheresis or thyroidectomy in refractory cases

Which Department to Visit?

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

Learn About Acil Servis Department

Let us help you

You can make an appointment with our specialists or contact us for your concerns.

Book AppointmentContact Us

Related Health Topics

Other articles from the same department you may want to explore.

Heart Attack First Aid

Acil Servis

Quick recognition and an emergency call in a heart attack dramatically improve the chance of survival.

Stroke Symptoms and FAST Test

Acil Servis

The FAST (Face, Arms, Speech, Time) test is the most practical method for early detection of stroke.

Anaphylaxis (Anaphylactic Shock)

Acil Servis

Anaphylaxis is a severe systemic allergic reaction; epinephrine injection and 112 are the most critical initial interventions.

Respiratory Failure

Acil Servis

Respiratory failure is a life-threatening state characterized by low blood oxygen or rising carbon dioxide.

Poisoning First Aid

Acil Servis

In poisoning, identifying the correct substance and knowing when not to induce vomiting is critical.

Burn Treatment and First Aid

Acil Servis

Emergency treatment for burns varies by degree and extent, starting with cooling and extending to specialist care.

Head Trauma First Aid

Acil Servis

Regardless of the impact severity in head trauma, emergency neurological evaluation is mandatory if there is any change in consciousness.

Emergency Assessment of Chest Pain

Acil Servis

In a patient with chest pain, ECG and cardiac biomarkers rapidly help to distinguish heart attack and pulmonary embolism from other causes.

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.