Thyroid Storm (Thyroid Crisis)
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[edit | edit source]
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[edit | edit source]
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[edit | edit source]
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
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