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Thyroid Storm

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Evidence-Based Critical Care

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Abstract

Thyroid storm represents an extreme augmentation of the manifestations of severe thyrotoxicosis. It is one of the most critical illnesses in the continuum of endocrine emergencies. Prompt recognition and management are crucial to prevent the high morbidity and mortality that can accompany thyroid storm. The mortality rate of thyroid storm can be substantial, ranging from 10 to 30 % of cases. In this chapter the pertinent principles of management will be reviewed. We will also review the common precipitating factors and hypotheses regarding the development of thyroid storm. Patient presentation, diagnosis, and treatment will be examined, along with diagnostic scoring tools and specific medications used in the management of thyroid storm. As part of the evidence contour we will assess other less commonly used therapies for thyroid storm, including L-Carnitine and extracorporeal plasmapheresis.

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References

  1. Nylen ES, Alarifi AA. Humoral markers of severity and prognosis of critical illness. Best Pract Res Clin Endocrinol Metab. 2001;15:553–73.

    Article  CAS  PubMed  Google Scholar 

  2. Dillmann WH. Thyroid Storm. Curr Ther Endocrinol Metab. 1997;6:81–5.

    CAS  PubMed  Google Scholar 

  3. Akamizu T, Satoh T, Iozaki O, Suzuki A, Wakino S, Iburi T, et al. Diagnostic criteria, clinical features, and incidence of thyroid storm based on nationwide surveys. Thyroid. 2012;22:661–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Burch HB, Wartofsky L. Life-threatening thyrotoxicosis. Thyroid storm. Endocrinol Metab Clin North Am. 1993;22:263–77.

    CAS  PubMed  Google Scholar 

  5. Sarlis NJ, Gourgiotis L. Thyroid emergencies. Rev Endocr Metab Disord. 2003;4:129.

    Article  PubMed  Google Scholar 

  6. Papi G, Corsello SM, Pontecorvi A. Clinical concepts on thyroid emergencies. Front Endocrinol. 2014;5:102.

    Article  Google Scholar 

  7. Chong HW, See KC, Phua J. Thyroid storm with multiorgan failure. Thyroid. 2010;20:333–6.

    Article  PubMed  Google Scholar 

  8. Jiang YZ, Hutchinson KA, Bartelloni P, Manthous CA. Thyroid storm presenting as multiple organ dysfunction syndrome. Chest. 2000;118:877–9.

    Article  CAS  PubMed  Google Scholar 

  9. Martinez-Diaz GJ, Formaker C, Hsia R. Atrial fibrillation from thyroid storm. J Emerg Med. 2012;42:e7–9.

    Article  PubMed  Google Scholar 

  10. Kobayashi C. Severe starvation hypoglycemia and congestive heart failure induced by thyroid crisis, with accidentally induced severe liver dysfunction and disseminated intravascular coagulation. Intern Med. 2005;44:234–9.

    Article  PubMed  Google Scholar 

  11. Abbasi B, Sharif Z, Sprabery LR. Hypokalemic thyrotoxic periodic paralysis with thyrotoxic psychosis and hypercapnic respiratory failure. Am J Med Sci. 2010;340:147–53.

    Article  PubMed  Google Scholar 

  12. Hsiao FC, Hung YJ, Hsieh CH, Wu LY, Shih KC, He CT. Abdominal pain and multiorgan dysfunction syndrome in a young woman. Am J Med Sci. 2007;334:399–401.

    Article  PubMed  Google Scholar 

  13. Ngo SY, Chew HC. When the storm passes unnoticed – a case series of thyroid storm. Resuscitation. 2007;73:485.

    Article  PubMed  Google Scholar 

  14. Bajwa SS, Jindal R. Endocrine emergencies in critically ill patients: challenges in diagnosis and management. Indian J Endocr Metab. 2012;16:722–7.

    Article  Google Scholar 

  15. Ross DS. Thyroid storm. In: Cooper DS, editor. UpToDate, Waltham: UpToDate. Accessed on 14 Jan 2015.

    Google Scholar 

  16. Pimental L, Hansen KN. Thyroid disease in the emergency department: a clinical and laboratory review. J Emerg Med. 2005;28:201–9.

    Article  Google Scholar 

  17. Nayak B, Burman K. Thyrotoxicosis and thyroid storm. Endocrinol Metab Clin North Am. 2006;35:663.

    Article  CAS  PubMed  Google Scholar 

  18. Hull K, Horenstein R, Naglieri R, Munir K, Ghany M, Celi FS. Two cases of thyroid storm-associated cholestatic jaundice. Endocr Pract. 2007;13:476–80.

    Article  PubMed  Google Scholar 

  19. Brunette DD, Rothong C. Emergency department management of thyrotoxic crisis with esmolol. Am J Emerg Med. 1991;9:232.

    Article  CAS  PubMed  Google Scholar 

  20. Cooper DS, Saxe VC, Meskell M, et al. Acute effects of propylthiouracil (PTU) on thyroidal iodide organification and peripheral iodothyronine deiodination: correlation with serum PTU levels measured by radioimmunoassay. J Clin Endocrinol Metab. 1982;54:101.

    Article  CAS  PubMed  Google Scholar 

  21. Nabil N, Miner DJ, Amatruda JM. Methimazole: an alternative route of administration. J Clin Endocrinol Metab. 1982;54:180.

    Article  CAS  PubMed  Google Scholar 

  22. Walter Jr RM, Bartle WR. Rectal administration of propylthiouracil in the treatment of Graves’ disease. Am J Med. 1990;88:69.

    Article  PubMed  Google Scholar 

  23. Kinoshita H, Yasuda M, Furumoto Y, et al. Severe duodenal hemorrhage induced by Lugol’s solution administered for thyroid crisis treatment. Intern Med. 2010;49:759.

    Article  PubMed  Google Scholar 

  24. Tsatsoulis A, Johnson EO, Kalogera CH, et al. The effect of thyrotoxicosis on adrenocortical reserve. Eur J Endocrinol. 2000;142:231.

    Article  CAS  PubMed  Google Scholar 

  25. Mazzaferri EL, Skillman TG. Thyroid storm. A review of 22 episodes with special emphasis on the use of guanethidine. Arch Intern Med. 1969;124:684.

    Article  CAS  PubMed  Google Scholar 

  26. Langley RW, Burch HB. Perioperative management of the thyrotoxic patient. Endocrinol Metab Clin North Am. 2003;32:519.

    Article  PubMed  Google Scholar 

  27. Ross DS. Iodinated radiocontrast agents in the treatment of hyperthyroidism. In: Cooper DS, editor. UpToDate. Waltham: UpToDate. Accessed on 16 Jan 2015.

    Google Scholar 

  28. Caldwell G, Errington M, Toft AD. Resistant hyperthyroidism induced by sodium iopodate used as treatment for Graves’ disease. Acta Endocrinol (Copenh). 1989;120:215.

    CAS  Google Scholar 

  29. Vyas AA, Vyas P, Fillipon NL, et al. Successful treatment of thyroid storm with plasmapheresis in a patient with methimazole induced agranulocytosis. Endocr Pract. 2010;16:673.

    Article  PubMed  Google Scholar 

  30. Benvenga S, Lapa D, Cannavo S, Trimarchi F. Successive thyroid storm treated with L-carnitine and low doses of methimazole. Am J Med. 2003;115:417–8.

    Article  PubMed  Google Scholar 

  31. Benvenga S, Ruggeri RM, Russo A, Lapa D, Campenni A, Trimarchi F. Usefulness of L-carnitine, a naturally occurring peripheral antagonist of thyroid hormone action, in iatrogenic hyperthyroidism: a randomized, double-blind, placebo-controlled clinical trial. J Clin Endocrinol Metab. 2001;86:3579–94.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Medicine, Section of Pulmonary, Critical Care and Sleep Medicine, Norwalk Hospital, Norwalk, CT, USA

    Matthew E. Schmitt & Robyn Scatena

  2. Yale University School of Medicine, New Haven, CT, USA

    Robyn Scatena

Authors
  1. Matthew E. Schmitt
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  2. Robyn Scatena
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Correspondence to Matthew E. Schmitt .

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Editors and Affiliations

  1. Division of Pulmonary and Critical Care, University of Michigan, Ann Arbor, Michigan, USA

    Robert C. Hyzy

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Schmitt, M.E., Scatena, R. (2017). Thyroid Storm. In: Hyzy, R. (eds) Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-43341-7_48

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  • DOI: https://doi.org/10.1007/978-3-319-43341-7_48

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43339-4

  • Online ISBN: 978-3-319-43341-7

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