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Thyrotoxic Crisis: Thyroid Storm

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Endocrine Emergencies

Part of the book series: Contemporary Endocrinology ((COE,volume 74))

Abstract

Thyroid storm (thyrotoxic crisis) is a rare but life-threatening condition in which acute severe thyrotoxicosis leads to organ system decompensation. Prompt diagnosis is based on clinical grounds and biochemical evaluation, although there are no specific thyroid function test levels that distinguish this syndrome from uncomplicated thyrotoxicosis. The point scale developed by Burch and Wartofsky (Table 9.2) is a useful objective mean to evaluate the severity of this syndrome. The pathogenesis of thyroid storm is complex and the clinician must be alert to identify precipitant factors. Management requires a multisystem approach in an Intensive Care Unit setting that is targeted to (1) inhibit thyroid hormone synthesis and release; (2) counteract the peripheral and biologic effects of thyroid hormones; and (3) treat systemic complications and precipitant factor(s).

Thyroid storm (thyrotoxicosis crisis) is a rare but life-threatening state of acute severe thyrotoxicosis characterized by organ system decompensation. Early recognition and appropriate management (ideally in an intensive care unit) of this life-threatening thyrotoxicosis is essential to prevent the high morbidity and mortality associated with this syndrome. The incidence of thyroid storm is about 1–2 % among patients with overt hyperthyroidism. It occurs mainly in the elderly and is three to five times more common in women than in men. The mortality rate ranges from 10 to 20 %, but it might be as high as 75 % if appropriate therapy is delayed. If death occurs it is most likely to be cardiopulmonary failure, particularly in the elderly [1].

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Authors and Affiliations

  1. Section of Endocrine, Medstar Washington Hospital Center, 110 Irving St NW Suite 2A-72, Washignton, DC, 20010, USA

    John J. Reyes-Castano M.D.

  2. Endocrine Section, Georgetown University Medical Center/MedStar Washington Hospital Center, 110 Irving St NW, Suite 2A-72, Washignton, DC, 20010, USA

    Kenneth Burman M.D.

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  1. John J. Reyes-Castano M.D.
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Correspondence to Kenneth Burman M.D. .

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  1. Department of Medicine, Oregon Health Sciences University, Portland, USA

    Lynn Loriaux

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Reyes-Castano, J.J., Burman, K. (2014). Thyrotoxic Crisis: Thyroid Storm. In: Loriaux, L. (eds) Endocrine Emergencies. Contemporary Endocrinology, vol 74. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-697-9_9

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