Thyroid Storm: What You Need to Know

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Graves' disease is an autoimmune disease that typically causes hyperthyroidism -- an overactive thyroid gland producing too much thyroid hormone. If you are hyperthyroid, you have a small risk of developing a condition known as thyroid storm. 

Thyroid storm is not common. Only to two percent of people who have active hyperthyroidism develop thyroid storm.

During a thyroid storm, your heart rate, blood pressure, and body temperature can become uncontrollably high.

These symptoms are serious, and can be life-threatening. Complications of thyroid storm include stroke and heart attack.

If You Suspect Thyroid Storm, Go to the ER Immediately

Whenever thyroid storm is suspected, you must go immediately on an emergency basis to the hospital. Thyroid storm is life-threatening, and can develop and worsen quickly. Thyroid storm requires immediate treatment to prevent life-threatening complications.   

Risk Factors for Thyroid Storm

The primary risk factor for thyroid storm is having Graves' disease and/or hyperthyroidism that is untreated. 

Additionally, women are at greater risk than men, and seniors are more at risk than younger people with Graves'/hyperthyroidism. 

Even when the Graves' disease is identified and being treated, however, there are a number of other factors that raise your risk of thyroid storm:

  • Infection, specifically lung infections, throat infections or pneumonia.
  • Blood sugar changes, including diabetic ketoacidosis and insulin-induced hypoglycemia.
  • Recent surgery to your thyroid gland, or trauma to your thyroid.
  • Abrupt withdrawal of your antithyroid medications.
  • Radioactive iodine (RAI) treatment of your thyroid.
  • Excessive palpation (handling/manipulation) of your thyroid gland.
  • Exposure to a large quantity of iodine (such as a iodine-based contrast agent, or the heart drug amiodarone). 
    Severe emotional stress.
  • An overdose of thyroid hormone drugs.
  • Toxemia of pregnancy and labor.

Symptoms of Thyroid Storm

What are the symptoms of thyroid storm?

  • A very high fever of 100 degrees to as high as 106 degrees.
  • A very high heart rate, which can be as high as 200 beats per minute (BPM). 
  • Palpitations, chest pain, and shortness of breath.
  • High blood pressure.
  • Confusion, delirium, and even psychosis.
  • Extreme physical and muscle weakness
  • Extreme fatigue and exhaustion.
  • Extreme restlessness, nervousness, and mood swings.
  • Exaggerated reflexes, especially in knee and ankle areas.
  • Difficulty breathing.
  • Nausea, vomiting, and diarrhea.
  • Profuse sweating or dehydration.
  • Stupor or coma

One risk factor/symptom is that a dramatic weight loss may have taken place recently.

Physicians have developed a scoring system that helps them quickly assess symptoms and make a presumptive diagnosis of thyroid storm, so they can rapidly begin treatment.

 

How is Thyroid Storm Treated? 

Thyroid storm is treated with a number of approaches.

Some doctors refer to the "five Bs" when treating thyroid storm. 

  • Block the synthesis of thyroid hormone - using antithyroid drugs. This is typically done right away with larger initial loading doses, and frequent administration of additional doses. In patients who can't tolerate antithyroid drugs, lithium is sometimes used
  • Block the release of thyroid hormone - using a potassium iodide preparation. This is usually given after the antithyroid drugs, and helps suppress thyroid hormone release.  
  • Block T4 to T3 conversion - using a corticosteroid drug, such as hydrocortisone 
  • Beta-blocker -- use a beta-blocker drug, frequently propranolol, to reduce blood pressure and heart rate
  • Block the circulation to the liver -- using a drug like cholestyramine

In addition, other supportive treatment includes cooling to help reduce body temperature, fluids to combat dehydration, and treatment of any other infections.

Typically, if the treatments are going to work, the improvement will be seen within 24 to 72 hours. 

When thyroid storm does not respond to these approaches, in some cases, plasmapheresis -- a blood filtering treatment -- is done to remove thyroid hormone from the bloodstream. Only a small percentage of the hormone can be removed during each session, so it needs to be performed several times. 

In rare cases, the thyroid is surgically removed, but physicians have to be particularly careful as the surgery can precipitate a worsening of thyroid storm if hormone levels are already high.

What Should You Do?

Thyroid storm is very rare, but it is a dangerous complication of hyperthyroidism. If you suspect thyroid storm, you must immediately seek emergency medical care. 

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