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Thyroid Storm


Svetla BankovaThyroid Storm- Dangers and Prevention

by Svetla Bankova

Thyroid storm is a severe, life-threatening condition caused by an excess of thyroid hormone. A number of factors can be involved in causing thyroid storm, including over-replacement of thyroid hormones or discontinuing medications taken to treat hyperthyroidism.  Do not discontinue your medication without the permission of your doctor. This could be very dangerous for your health!

Symptoms of thyroid storm can include fever (potentially as high as 105-106 degrees F), racing pulse, nausea, vomiting, diarrhea, irregular heart beat, confusion, and weakness. Thyroid storm may lead to heart failure and requires emergent medical treatment.

Thyroid Storm Symptoms

1. Hyperpyrexia, temperature in excess of 106oC, dehydration.

2. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure.

3. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction.

4. Confusion, agitation, delirium, frank psychosis, seizures, stupor or coma

Presently, the most common cause of thyroid storm is intercurrent illness or infection (i.e., medical storm). Other reasons include, but are not limited to:

    • Infection
    • Emotional stress
    • Tooth extraction
    • Diabetic ketoacidosis
    • Hypoglycemia
    • Trauma
    • Bowel infarction
    • Parturition
    • Toxemia of pregnancy

The therapeutic options for thyroid storm are the same as those for uncomplicated hyperthyroidism, except that the drugs are given in higher doses and more frequently. In addition, full support of the patient in an intensive care unit is essential, since the mortality rate of thyroid storm is substantial.

The therapeutic regimen typically consists of multiple medications, each of which has a different mechanism of action:

  • A beta-blocker to control the symptoms induced by increased adrenergic tone. 
  • A thionamide, such as methimazole, to block new hormone synthesis. 
  • An iodinated radiocontrast agent to inhibit the peripheral conversion of T4 to T3. 
  • An iodine solution to block the release of thyroid hormone. 
  • Glucocorticoids to reduce T4-to-T3 conversion and possibly treat the autoimmune process in Graves’ disease.
  • Acetaminophen is the drug of choice, as aspirin may displace thyroid hormone from binding sites and increase severity of thyroid storm.
  • Cooling blankets, ice packs, and alcohol sponges encourage dissipation of heat. Use of a cooled humidified oxygen tent is advised.

So said, do not underestimate the danger of thyroid storm. To learn about treatment options for treating Graves’ Disease and Hyperthyroidism, click here:

Graves’ Disease Treatment Options