Thyroid Storm: An Emergency of the Thyroid

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Medical Author: Ruchi Mathur, MD
Medical Editor: Melissa Conrad Stoppler, MD

There are really not many emergencies that we need to worry about regarding the thyroid gland - but thyroid storm is one of the rare exceptions.

Thyroid storm is a crisis or life-threatening condition characterized by an exaggeration of the usual physiologic response seen in hyperthyroidism. Whereas hyperthyroidism can cause symptoms such as sweating, feeling hot, palpitations and weight loss - symptoms of thyroid storm are more severe, resulting in complications such as:

• fever
• rapid heart rate
• nausea/vomiting
• diarrhea
• irregular heart beat
• weakness
• heart failure
• confusion/disorientation

Fever tends to be one of the hallmarks of thyroid storm and can be as high as 105-106F. The actual diagnosis of thyroid storm is made on the basis of suspicion in patients with symptoms, and in the setting of elevated blood levels of thyroid hormones (T3 and T4). Conditions such as severe sepsis, pheochromocytoma, and malignant hyperthermia can mimic thyroid storm.

Causes of thyroid storm may include:

• discontinuing needed medications for hyperthyroidism
• over-replacement of thyroid hormone
• recent treatment with radioactive iodine
• severe infection or illness, usually in a patient with hyperthyroidism
• severe medical stressors, such as heart attack, in a patient with hyperthyroidism

Thyroid storm requires emergent treatment and hospitalization. The main treatment is to decrease the circulating thyroid hormone levels and decrease their formation. PTU and methimazole are two agents that decrease thyroid hormone synthesis and are usually prescribed in fairly high doses. To inhibit thyroid hormone release from the thyroid gland, sodium iodide, potassium iodide and/or Lugol's solution can be given. Beta blockers such as propranolol (Inderal, Inderal LA) can help to control the heart rate, and intravenous steroids may be used to help support the circulation.

Earlier in this century, the mortality of thyroid storm approached 100%. However, now, with the use of aggressive therapy as described above, the death rate from thyroid storm is less than 20%.