Thyroid Storm: Poorly Studied and Potentially Fatal

According to a story from Medscape, thyroid storm is a collection of symptoms that can be described as acute hyperthyroidism (overactivity of the thyroid gland) or thyrotoxicosis, a condition of excess thyroid hormone in the body. This state is dangerous and potentially lethal, but despite this fact there hasn’t been much research focused on it. In fact, there is not definitive diagnostic test for the condition, and the evidence for the methods most often used to treat it is limited as well.

New Studies Needed

Dr. Stephanie B. Meyer says that thyroid storm is in effect a purely “clinical diagnosis and a clinical judgment.” This means that determining if someone has it is purely based on the symptoms and signs that the patient is displaying; there are not distinct biochemical standard or definitive abnormalities that have been established in the laboratory setting. Thyroid storm is definitely rare and, unfortunately, that means that there are no trials studying its treatment at this juncture. The fact that the 2016 practice guidelines listed on the American Thyroid Association website (which haven’t been updated since) are based on findings from the 70’s and 80’s makes it clear that the study of this condition has lapsed.

Ultimately, the fact that thyroid storm is rare doesn’t mean that hospitals shouldn’t be prepared, especially given its life-threatening nature. In a retrospective analysis, thyroid storm was implicated in 16 percent of hospital discharges in which thyrotoxicosis was diagnosed, which included over 121,000 cases.

How to Identify Thyroid Storm

Guidelines for diagnosis put forth by the Japan Thyroid Association and the Japan Endocrine Society may be among the most effective. Three prerequisites for the diagnosis of thyroid storm include:

  1. Low thyroid stimulating hormone.
  2. Elevated free or total triiodothyronine.
  3. Elevated free thyroxine.

These prerequisites establish that the patient is also in a state of thyrotoxicosis. These guidelines also emphasize the potential for behavioral disturbances, which may include:

  • Lethargy
  • Coma
  • Restlessness
  • Psychosis
  • Agitation
  • Delirium

Other signs to look out for include:

  • Nausea, vomiting, and hyperdefecation
  • Signs of heart failure
  • A fever of 100.4°F or more
  • Heart rate of 130 bpm or more

Find The Trigger

Generally, an additional change in the body triggers the onset of thyroid storm in patients with thyrotoxicosis. These trigger may include infections, sudden halt of thyroid medication, injury, or pulmonary embolism. Often treating or correcting the triggering event is the most important method for shutting down the thyroid storm. Other measures, such as cooling blankets, fluid and electrolyte replacement, and oxygen supplementation may be needed.

Treatment

To halt the storm, medications must be employed that can halt the creation of more thyroid hormone, such as propylthiouracil. Iodine can also prevent any hormone that has already been synthesized from being released. Other treatments may include beta blockers, glucocorticoids, acetaminophen, and plasmapheresis.

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