Thyroid Storm

A thyroid storm can be considered to be an extreme degree of hyperthyroidism and typically occurs in an individual with untreated hyperthyroidism.

• Located at the front part of the neck, the thyroid gland is responsible for making substances (thyroid hormones) essential for all body cells to work properly.
• In certain conditions, the thyroid becomes over-active and produces too much thyroid hormone in the body, a state called hyperthyroidism.
• People with hyperthyroidism have problems from over-activity of several organs, resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and sometimes eye problems.

How do I know if I'm having a thyroid storm?

• When thyroid hormone levels become very high, the symptoms worsen and can result in a serious condition called thyroid storm or thyrotoxic crisis.
• One major sign of thyroid storm that differentiates it from ordinary hyperthyroidism is a marked elevation of body temperature, which may be as high as 105-106 F (40.5-41.1 C).
• A thyroid storm is unusual but is a life-threatening emergency when it does occur. People experiencing symptoms of thyroid storm should be promptly taken to an emergency department.
• A thyroid storm is always a medical emergency.
• A thyroid storm can be prevented with early treatment of hyperthyroidism.

A thyroid storm can be considered to be an extreme degree of hyperthyroidism and typically occurs in an individual with untreated hyperthyroidism. Precipitating factors, including trauma and stresses, have been identified, including:

• Infections, especially of the lung
• Thyroid surgery in patients with the overactive thyroid gland
• Stopping medications given for hyperthyroidism
• Treatment with radioactive iodine
• Pregnancy
• Heart attack or cardiac emergencies

9 Common signs and symptoms of a thyroid storm include:

• Rapid heartbeat (palpitations)
• Greatly increased body temperature
• Chest pain
• Shortness of breath
• Anxiety and irritability
• Disorientation
• Increased sweating
• Weakness
• Heart failure

If you have any of the following conditions, call your doctor immediately:

• Fever
• Very rapid heartbeats
• Confusion and disorientation
• Significant fatigue and exhaustion

Friends or family members of anyone experiencing symptoms of thyroid storm (who may not be able to function normally) should take the affected individual to an emergency department immediately.

The following five tests are usually performed to diagnose thyroid storm:

• blood cell count,
• electrolyte levels,
• blood sugar level,
• liver function, and
• thyroid hormone levels.

People experiencing thyroid storms are not able to function normally. A thyroid storm is always a medical emergency. People experiencing symptoms of thyroid storm should be taken to the nearest hospital because thyroid storm is an extremely dangerous condition that can lead to death.

Treatment of thyroid storm consists of life support measures to support vital organ function along with attempts to reduce thyroid hormone release. A complete evaluation to determine the cause of thyroid storm will also be carried out along with treatment of underlying or precipitating diseases or conditions. Treatment and supportive measures can include:

• A complete evaluation to determine the cause of thyroid storm
• Intravenous fluids and electrolytes
• Oxygen if needed
• Fever control with antipyretics (fever-reducing medications) and if needed cooling blankets
• Intravenous corticosteroids such as hydrocortisone
• Medications to block the production of thyroid hormones, such as propylthiouracil (PTU) or methimazole (Northyx, Tapazole)
• Iodide blocks thyroid hormone release
• Drugs called beta-blockers, such as propranolol (Inderal) block the action of thyroid hormones in the body
• Treatment of heart failure if present

• Following the start of treatment, careful monitoring is necessary, usually in the intensive care unit.
• Following recovery from thyroid storm, options for definitive treatment include radioactive iodine or antithyroid medications. Surgery to remove the thyroid gland is rarely needed.
• Follow-up with the doctor after discharge is important to monitor the thyroid condition and formulate a plan for curative treatment.

Thyroid storm can be prevented with early treatment of hyperthyroidism and recognition of the warning symptoms of thyroid storm.

• Thyroid storm is a very serious condition that can result in death.
• Early and aggressive treatment can improve the outcome