Thyroid Storm

Abstract

Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well understood. A heightened response to thyroid hormone is often incriminated along with increased or abrupt availability of free hormones. Patients exhibit exaggerated signs and symptoms of hyperthyroidism and varying degrees of organ decompensation. Treatment should be initiated promptly targeting all steps of thyroid hormone formation, release, and action. Patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality of thyroid storm is currently reported at 10%. Patients who have survived thyroid storm should receive definite therapy for their underlying hyperthyroidism to avoid any recurrence of this potentially fatal condition.

Acute Suppurative Thyroiditis Accompanied by Thyrotoxicosis after Fine-Needle Aspiration: Treatment with Catheter Drainage

“…Because, in our case, the activity was increased outside a cold area in which abscess developed and antithyroid therapy was started. If we didn't start to antithyroid therapy thyrotoxicosis may lead to thyroid storm, the worst complication of hyperthyroidism [14]. This can further exacerbate the existing picture.…”

Thyroid storm: A rare and life-threatening cause of acute neurological manifestations during urgent percutaneous coronary intervention for acute coronary syndrome

“…Periprocedural ischemic or hemorrhagic stroke remains the most common cause with an incidence of 0.07-0.38% and is associated with high rates of morbidity and mortality [2]. However, sudden-onset neurological symptoms during diagnostic CAG or percutaneous coronary intervention (PCI) may result from rarer albeit fatal neurological or endocrine conditions, such as seizure, encephalopathy, contrast media-induced neurotoxicity or acute thyrotoxicosis [3]. Thyroid storm (TS) is a life--threatening endocrine emergency that represents the extreme manifestation of acute thyrotoxicosis and is associated with high morbidity and mortality (10%) rates if left untreated [3,4].…”

“…Acute TS is an extremely rare hypermetabolic condition induced by excessive thyroid hormones release in individuals with thyrotoxicosis with an annual incidence of 2/1,000,000 patients, but it remains associated with high mortality rates (10-30%) [3,4]. TS is a clinical diagnosis considering the absence of absolute circulating thyroid hormones levels cut-off and usually occurs following a precipitating event in patients with severe thyrotoxicosis or previously undiagnosed hyperthyroidism [3]. TS results from sudden inhibition of thyroid hormone binding to plasma proteins leading to further increase in thyroid hormone levels.…”

“…The main precipitating factors include irregular use or discontinuation of antithyroid drugs as well as iodinated contrast media administration. However, no clear trigger may be identified in 25-43% of patients [3]. The Burch and Wartofsky's score is a scoring system based on clinical features proposed to guide the diagnosis of TS, particularly when thyroid hormone assays are not readily available [5].…”

“…The Burch and Wartofsky's score is a scoring system based on clinical features proposed to guide the diagnosis of TS, particularly when thyroid hormone assays are not readily available [5]. Considering high mortality rates [4], medical treatment of TS should be initiated promptly and be aimed at treating the underlying condition, alleviating catecholamine-dependent mechanisms and peripheral effects of thyroid hormone excess, inhibiting new thyroid hormone synthesis and release, removing circulating thyroid hormones and enhancing thyroid hormone clearance [3,6]. Acute thyrotoxicosis with abrupt onset of neurological symptoms and delirium precipitated by administration of iodinated contrast media during CAG procedures has been previously reported [3].…”