Thyroid Storm (Thyroid Crisis)

 

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Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Chelsea Reed, Elaine Lonnemann, Lucinda hampton, Kim Jackson, WikiSysop and Adam Vallely Farrell  

Definition/Description

An acute, life-threatening exacerbation of thyrotoxiosis. This condition is rare now due to more efficient diagnosis and treatment of thyrotoxicosis in addition to improved management pre and post surgery. When it does occur, it is following illness, trauma, surgery or other major physiological stress in an individual with existing thyrotoxicity. Thyroid storm occurs most commonly in those with uncontrolled or undiagnosed thyrotoxicity without a precipitating factor. Individuals with a history of hyperthyroidism, Graves’ disease, toxic multinodular goiter, adenoma or any other cause of endogenous thyrotoxicity are at the highest risk for experiencing a thyroid storm. ^{[2] [4] [5]}

Prevalence

Rare, but high mortality rates at 10-20%.[1] Currently, incidence may be as low as 0.2 cases/100,000 population. [5] More common in women than men (10:1) [11].

Characteristics/Clinical Presentation

Classic presentation characterized by signs and symptoms of hypermetabolism including: ^{[1] [3] [5]}

• Severe tachycardia
• Elevated blood pressure
• Heart failure
• Peripheral edema
• Pulmonary edema
• Chest pain
• Hyperthermia (up to 105.3℉ or 40.7℃)
• Restlessness
• Agitation
• Delirium or psychosis
• Jaundice
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Profuse sweating
• Dehydration
• Tremor
• Coma

Central Features:^[4]

• Thyrotoxicosis
• Abnormal CNS function
• Fever
• Tachycardia (above 130bpm)
• GI tract symptoms
• Evidence of impending or present CHF

Elderly patients can have an atypical presentation characterized by: ^{[1] [5]}

• Apathy
• Stupor
• Weakness
• Cardiac failure
• Coma
• Minimal signs of thyrotoxicity
• Absent or low fever

Musculoskeletal Manifestations:
See hyperthyroidism

Associated Co-morbidities

• Hyperthyroidism
• Congestive heart failure
• Coronary artery disease
• Sjogren’s syndrome
• Rheumatoid arthritis
• Psoriatic arthritis
• Chronic periarthritis
• Myasthenia gravis ^[3]
  

Medications

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Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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Systemic Involvement

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Medical Management (current best evidence)

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Physical Therapy Management (current best evidence)

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Differential Diagnosis

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Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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