Thyroid Storm Basics

Thanks to Dr. Kopping for today’s Morning Report!

THYROID STORM

Thyrotoxicosis represents anywhere from 0.05% to 1.3%

• Storm represents <10% of hospitalized
• However untreated 80 to 100% mortality
• Drops to 20 to 30% with treatment

What makes the difference from thyrotoxicosis to thyroid storm?

• Comparable levels
• Precipitating factors- some sort of physiologic stressor
  • Infection(most common)
  • Trauma, MI, CVA, PE, DKA, surgery (particularly thyroid), Iodine administration(dye, amiodoarone), abruptly stopping antithyroid meds
• Adrenergic hyperactivity- release from binding sites or increase binding site sensitivity
  • Cause a lot of biochemical changes downstream that is beyond my capacity

When is it thyroid storm?

• Burch & Wartofsky Diagnostic Criteria (http://wikem.org/wiki/Thyroid_Storm)

5 Step Treatment Approach

1. Supportive care- IV, fever control, nutrition (dextrose, multivitamin, thiamine, folate), O2 as needed, cardiac monitoring
2. Inhibition of thyroid release- PTU (preferred) or methimazole
3. Inhibition of NEW thyroid release MUST be done AT LEAST 1 hour after (ie Lugol solution, potassium iodide, IV iopanoic acid, Iopdate, Lithium carbonate
4. B adrenergic receptor blockade (propranolol, esmolol, rerpine/guanethidine if BB contraindicated)
5. Prevent peripheral conversion (Hydrocortisone or dexamethasone)

Above all else…

FIND AND TREAT THE PRECIPITATING EVENT!!

References:

http://accessmedicine.mhmedical.com.newproxy.downstate.edu/content.aspx?bookid=348&sectionid=40381707

http://accessmedicine.mhmedical.com.newproxy.downstate.edu/ViewLarge.aspx?figid=40403707

Nayak, B; Burman, K “Thyrotoxicosis and Thyroid Storm”

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Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

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