Thyroid Storm
Thyroid storm is very rare, so the main challenge is considering it - Josh Farkas
image by: This Morning
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Thyroid Storm ED Diagnosis and Management
Making this diagnosis requires that you actually think about it in the first place. There is no single diagnostic test or image that will clinch this diagnosis for you. The Burch and Wartofsky criteria are clinical findings that you as the provider must use in the correct context for them to be useful. This is a rare condition, and your availability bias will be working against you here. Patient presentations can be vague and there is incredible overlap with other disease processes, with chief complaints ranging from anxiety to vomiting and abdominal pain to leg swelling.
Resources
Storm’s a Comin’: A Review of Thyrotoxicosis and Thyroid Storm
What is perhaps most challenging about thyroid storm is its propensity to present with nonspecific manifestations, which oftentimes mimic other clinical conditions.
Thyroid Storm
The diagnosis of thyroid storm is clinical. Laboratory testing, although helpful, does not distinguish between thyrotoxicosis and thyroid storm.1 Treatment should be started immediately based on clinical findings.2 The key clinical features are: fever, altered mental status, and signs of sympathetic over-activity.
Acute and emergency care for thyrotoxicosis and thyroid storm
Thyroid storm is a clinical diagnosis for patients with pre‐existing hyperthyroidism. In determining whether or not a patient has thyroid storm the main systems to concentrate on are the CNS (ranging from being agitated to seizure), thermoregulatory system (rise in temperature), cardiovascular system (ranging from tachycardia to atrial fibrillation and congestive cardiac failure [CCF]), and gastrointestinal–hepatic system (ranging from nausea to vomiting and jaundice).
Thyroid Storm – How to Recognize It and How to Treat It
Thyroid storm is a clinical diagnosis of increased end organ effects from thyroid hormone. The Burch-Wartofsky score (BWS) can be helpful to differentiate between a hyperthyroid state and thyroid storm.
Thyroid Storm: Treatment Strategies
Endocrinologic emergencies often fall at the wayside and are not generally considered as a possible diagnosis up front in patients in the emergency department who meet the criteria for systemic inflammatory response syndrome (SIRS). It becomes too easy to label them as “septic”, and we may forget that endocrinologic emergencies, specifically thyroid storm, can present in very much the same way. To me, it really is the missed mimic of several disease states, as described above in our possibly uroseptic patient.
Thyroid Storm ED Diagnosis and Management
Making this diagnosis requires that you actually think about it in the first place. There is no single diagnostic test or image that will clinch this diagnosis for you. The Burch and Wartofsky criteria are clinical findings that you as the provider must use in the correct context for them to be useful. This is a rare condition, and your availability bias will be working against you here. Patient presentations can be vague and there is incredible overlap with other disease processes, with chief complaints ranging from anxiety to vomiting and abdominal pain to leg swelling.
Core EM
Directed management starts with beta blockade to reduce the peripheral effects of thyroid hormone. This should be followed by corticosteroids, thionamides and inorganic iodine
EMCrit
Not a topic of specific expertise for me, but I wanted to get all of the info in one place for future use–Thyroid Storm.
emDocs
Thyroid storm is a rare clinical picture seen in severe thyrotoxicosis. The condition is a critical emergency presentation occurring in 1-2% of hyperthyroid patients, with treated mortality rates reported between 10-30%. While it can occur as the result of uncontrolled or poorly controlled hyperthyroidism, more often it is the result of an acute precipitating event acting on the increased catecholamine receptor expression of hyperthyroid patients.
Life in the Fastlane
... life threatening exacerbation of hyperthyroid state with 1 or more organ dysfunction.
SAEM
Although thyroid storm is primarily a clinical diagnosis, if thyroid storm is suspected thyroid specific laboratory studies should be obtained.
WikEM
When in doubt of diagnosis, the EP should treat given the high mortality rate, as a few doses of anti-thyroid medication are unlikely to harm euthyroid patient
EMCrit Project
Thyroid storm is the most severe form of hyperthyroidism, wherein organ failure begins to occur. If left untreated, this may lead to multi-organ failure and death. Due to the rarity of this condition and its multitude of diverse presentations, diagnosis can be extremely challenging.
ScienceDirect
Thyroid storm is a rare condition causing multiple organ system dysfunction in humans following massive overdoses of thyroid hormones, or in cases of untreated or undertreated hyperthyroidism.
StatPearls
Thyroid storm, also known as thyrotoxic crisis, is an acute, life-threatening complication of hyperthyroidism that presents with multi-system involvement. The mortality associated with thyroid storm is estimated to be 8-25% despite modern advancements in its treatment and supportive measures. Thus, it is very important to recognize it early and start aggressive treatment to reduce mortality.
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