Thyroid storm
Thyrotoxic storm; Thyrotoxic crisis; Hyperthyroid storm; Accelerated hyperthyroidism; Thyroid crisis; Thyrotoxicosis - thyroid stormThyroid storm is a very rare, but life-threatening condition of the thyroid gland that develops in cases of untreated thyrotoxicosis (hyperthyroidism, or overactive thyroid).
Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
The thyroid gland is located in the neck, just above where your collarbones meet in the middle.
Causes
Thyroid storm occurs due to a major stress such as trauma, heart attack, or infection in people with uncontrolled hyperthyroidism. In rare cases, thyroid storm can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease. This can occur even a week or more after the radioactive iodine treatment.
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
Graves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
Symptoms
Symptoms are severe and may include any of the following:
- Agitation
- Change in alertness (consciousness)
- Confusion
- Diarrhea
- Increased temperature
- Pounding heart (tachycardia)
Tachycardia
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.
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Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
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- Sweating
- Bulging eyeballs
Exams and Tests
The health care provider may suspect thyrotoxic storm based on:
- A high systolic (top number) blood pressure reading with a lower diastolic (bottom number) blood pressure reading (wide pulse pressure)
- A very high heart rate
- A history of hyperthyroidism
- An exam of your neck may find that your thyroid gland is enlarged (goiter)
Goiter
A simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.
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Blood tests are done to check thyroid hormones TSH, free T4 and T3.
TSH
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
T3
Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body's control of metabolism (the many processes that control the rate...
Other blood tests are done to check heart and kidney functions and to check for infection.
Treatment
Thyroid storm is life-threatening and requires emergency treatment. Often, the person needs to be admitted to the intensive care unit. Treatment includes supportive measures, such as giving oxygen and fluids in case of breathing difficulty or dehydration. Treatment may include:
- Cooling blankets to return the body temperature to normal
- Monitoring any excess fluid in older people with heart or kidney disease
- Medicines to manage agitation
- Medicine to slow the heart rate
- Vitamins and glucose
The final goal of treatment is to decrease the levels of thyroid hormones in the blood. Sometimes, iodine is given in high doses to try and stun the thyroid. Other drugs may be given to lower the hormone level in the blood. Beta blocker medicines are often given by vein (IV) to slow the heart rate, lower blood pressure, and block the effects of the thyroid hormone excess.
Antibiotics are given in case of infection.
Possible Complications
Irregular heart rhythms (arrhythmias) may occur. Heart failure and pulmonary edema can develop rapidly and cause death.
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Pulmonary edema
Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of breath.
When to Contact a Medical Professional
This is an emergency condition. Call 911 or another emergency number if you have hyperthyroidism and experience symptoms of thyroid storm.
Prevention
To prevent thyroid storm, hyperthyroidism should be treated.
References
Jonklaas J, Cooper DS. Thyroid. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 213.
Marino M, Vitti P, Chiovato L. Graves' disease. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 82.
Tallini G, Giordano TJ. Thyroid gland. In: Goldblum JR, Lamps LW, McKenney JK, Myers JL, eds. Rosai and Ackerman's Surgical Pathology. 11th ed. Philadelphia, PA: Elsevier; 2018:chap 8.
Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 120.
Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
Review Date: 1/26/2020
Reviewed By: Brent Wisse, MD, board certified in Metabolism/Endocrinology, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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