Thyroid Storm

Thyroid Storm General Information

Thyroid Storm is a medical condition that is developed by some (only 1 to 2 %) of the patients suffering from hyperthyroidism or Graves’ disease. This condition is often fatal if treatment is not applied as soon as possible – generally the condition becomes irreversible within a few hours from the start of the attack. The attack itself is known to start and worsen abruptly, and the patient may suffer complications such as heart attack or stroke. During an attack, the patient’s hyperthyroidism symptoms aggravate and the body temperature, heart rate and blood pressure may escalate to severely high levels. The patient should be immediately transported to a hospital, in order for emergency treatment to be applied.

Being affected by Graves’ disease or by hyperthyroidism and not treating the condition properly is one of the primary causes of Thyroid Storm onset. Other risk factors may include infections in the lungs or neck, pneumonia, changes in blood sugar levels, severe emotional stress; studies have also shown that females have a higher incidence rate than males. Other factors that may influence the onset of this condition are abrupt withdrawal of medication (especially antithyroid medication), radioactive iodine treatment, thyroid surgery, and excessive palpation of the thyroid gland, overdose with thyroid hormones or toxemia caused by pregnancy or labor. For more information regarding the risk factors, as well as for more details regarding the condition, it is advised that you consult a health care professional - either a physician, pharmacist or a nurse.

Thyroid Storm Symptoms

Thyroid Storm is a medical emergency which may result in the death of the patient if treatment is not immediately applied. It is defined by the exaggeration of the usual phenomena that are characteristic to hyperthyroidism, and as such, the symptoms are based on the general hyperthyroidism symptoms (sweating, palpitations, weight loss and hotness), but are more powerful and severe. One of the most common symptoms of Thyroid Storm is the fever, which may rise up to 106 F. Also, one of the characteristics of the condition is the high concentrations of thyroid hormones T3 and T4 in the patient’s blood. It is common that the patient also has a rapid and / or irregular heartbeat, and may be nauseous. Vomiting may also accompany the attack, and diarrhea may be present as well. Weakness and confusion / disorientation are also common in cases of Thyroid Storm, and often the patient may also be affected by heart failure.

In many cases the diagnosis is placed preventively, on the basis of suspicion if the patient presents any of the signs; however, there are a few medical conditions such as pheochromocytoma, hyperthermia or severe sepsis which present some of the same symptoms and may thus be misdiagnosed. Only thorough examination and testing will provide the health care professionals with the definitive diagnosis and will allow them to apply proper treatment. It is highly advised that if the patient presents any of the above symptoms, he or she is immediately brought under medical attention in order to clearly determine the condition he or she is suffering from and to start the appropriate treatment. Home treatment should not be employed unless a specialized health care professional has given clear permission to do so.

Thyroid Storm Treatment

Thyroid Storm is a medical condition that is handled by emergency room health care professionals only. Treatment must be applied immediately once the condition is suspected in a patient. If the patient is not in a medical facility when the attack occurs, he or she needs to be transported to an emergency room immediately. As soon as the patient arrives in the emergency room, he or she needs to be placed in a cardiac monitor, and intubation may be necessary. Supplemental oxygen should be provided at all times, and it is possible for aggressive fluid resuscitation to be required. The fever caused by the Thyroid Storm is typically relieved by employing cooling measures and antipyretic drugs; however Aspirin should be avoided as it may decrease protein binding thus leading to further increases in thyroid hormone levels. Electrolytes should be replaced as appropriate, according to the values obtained from the laboratory. Also the patient may require extensive hydration.

Also in cases of Thyroid Storm atrial fibrillation may be hard to control; the conversion to sinus rhythm may prove to be impossible and as such antithyroid therapy must be initiated first. If the patient is suspected of having adrenal insufficiency, it is indicated that he or she is administered IV glucocorticoids. Administration of Dexamethasone in large doses, of up to 2 mg q6h will inhibit the production of hormones and will decrease the rate of peripheral conversion of hormones from T4 to T3. Also, the antithyroid drugs assist in inhibiting the synthesis of t he T4 hormone, by blocking the organification of tyrosine residues. Examples of such drugs are Propylthiouracil and Methimazole. Propylthiouracil also has a minor inhibiting effect on the T4 hormone conversion to T3; however this is not significant in Thyroid Storm cases. The medication needs to be administered orally or, if the patient has been intubated, via the nasogastric tube. The effects typically appear within 1 hour from administration.

Both the above antithyroid drugs act by inhibiting the synthesis of new hormones but do not have any effectiveness on the release of the hormones that have already been formed. As such, iodine needs to be administered, but the administration should be performed only after the antithyroid medication has taken effect, typically after 1 hour from the antithyroid drug administration. That is to prevent the iodine from being used in the synthesis of additional quantities of hormones. If the patient is allergic to iodine, lithium may be used to achieve the same results. In order to treat the symptoms of Thyroid Storm thyrotoxicosis, beta-adrenergic blockers are the main choice. From these categories of medication, Propranolol is preferred, as it also has an effect of blocking the peripheral conversion of the T4 hormone to T3. Once the patient’s state is stable, he or she may be kept for a while under medical monitoring.