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Disease

Thyroid storm

Thyrotoxic storm; Thyrotoxic crisis; Hyperthyroid storm; Accelerated hyperthyroidism; Thyroid crisis; Thyrotoxicosis - thyroid storm

Thyroid storm is a very rare, but life-threatening condition of the thyroid gland that develops in cases of untreated thyrotoxicosis (hyperthyroidism, or 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.

Symptoms

Symptoms are severe and may include any of the following:

  • Agitation
  • Change in alertness (consciousness)
  • Confusion
  • Diarrhea
  • Increased temperature
  • Pounding heart (tachycardia)
  • Restlessness
  • Shaking
  • Sweating
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 may be low
  • An increased heart rate

Blood tests are done to check thyroid hormones TSH, free T4 and T3.

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 difficult breathing or dehydration. Treatment may include any of the following:

  • 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
  • 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.

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

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.

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.

Review Date: 2/22/2018

Reviewed By: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, 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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