Thyroid Storm is a rare, life-threatening condition of thyrotoxicosis, often precipitated by an acute event such as thyroid or nonthyroidal surgery, trauma, infection, an acute iodine load, or parturition.
The advent of appropriate preoperative preparation of patients undergoing thyroidectomy for hyperthyroidism has led to a dramatic reduction in the prevalence of surgically-induced thyroid storm.
Total T4 and T3 levels might be similar to those seen in uncomplicated patients, the free T4 and free T3 concentrations were higher in patients with thyroid storm.
Symptoms
– Tachycardia to rates that can exceed 140 beats/minute
– Congestive heart failure
– Hypotension
– Cardiac arrhythmia
– Hyperpyrexia to 104 to 106ºF is common
– Agitation, anxiety, delirium, psychosis, stupor or coma are also common and are considered by many to be essential to the diagnosis
–– Severe nausea, vomiting, diarrhea, abdominal pain, or hepatic failure with jaundice can also occur.
In 1993, Burch and Wartofsky1 introduced a scoring system using precise clinical criteria for the identification of thyroid storm. Many other criterias were also proposed but none of them is specific enough to be accepted in clinical practice.
Diagnosis: Total score of more than 45 is highly suggestive of thyroid storm, 25 to 44 supports the diagnosis, and less than 25 makes the diagnosis unlikely.1–3
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