Thyroid storm
Thyrotoxic storm; Thyrotoxic crisis; Hyperthyroid storm; Accelerated hyperthyroidism; Thyroid crisis; Thyrotoxicosis - thyroid stormThyroid storm is a rare life-threatening condition of the thyroid gland. It develops in cases of untreated hyperthyroidism, or overactive thyroid (thyrotoxicosis).
Hyperthyroidism
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
The thyroid gland is located in the neck, just above where your collarbones meet in the middle.
Causes
Thyroid storm occurs in people with uncontrolled hyperthyroidism due to a major stress such as:
- Trauma
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Heart attack
Heart attack
Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. ...
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Rarely, thyroid storm can be caused by radioactive iodine therapy for Graves disease. This can occur even a week or more after treatment.
Graves disease
Graves disease is an autoimmune disorder that leads to an overactive thyroid gland (hyperthyroidism). An autoimmune disorder is a condition that occ...
Symptoms
Symptoms are severe and may include any of the following:
- Agitation
- Change in alertness (consciousness)
- Confusion
- Diarrhea
- Increased temperature
- Pounding heart (tachycardia)
Tachycardia
A bounding pulse is a strong throbbing felt over one of the arteries in the body. It is due to a forceful heartbeat.
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Restlessness
Restlessness
Agitation is an unpleasant state of extreme arousal. An agitated person may feel stirred up, excited, tense, confused, or irritable.
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- Sweating
- Bulging eyeballs
Exams and Tests
Your 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 (wide pulse pressure)
- A very high heart rate
- A history of hyperthyroidism
- An exam of your neck may find that your thyroid gland is enlarged (goiter)
Goiter
A simple goiter is an enlargement of the thyroid gland. It is usually not a tumor or cancer.
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Blood tests are done to check the levels of the thyroid hormones TSH, free T4 and T3.
TSH
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
Free T4
T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood. Fre...
T3
Triiodothyronine (T3) is a thyroid hormone. It plays an important role in the body's control of metabolism (the many processes that control the rate...
Other blood tests are done to check heart and kidney functions and to check for infection. Liver function tests provide added diagnosis and treatment information.
Treatment
Thyroid storm is a medical emergency. It is life threatening. Often, the person needs to be admitted to the intensive care unit. Treatment may include:
- Oxygen therapy for breathing problems
- Fluids for dehydration
- 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
- Medicine to slow the heart rate
- Vitamins and glucose
The goal of treatment is to decrease thyroid hormone levels in the blood. Sometimes, high doses of iodine is given to try and stun the thyroid. Other medicines known as thionamides 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. In some severe cases, glucocorticoids (steroids) are given.
Antibiotics are given in case of infection.
Possible Complications
Irregular heart rhythms (arrhythmias) may occur. Heart failure and fluid in the lungs (pulmonary edema) can develop rapidly and cause death.
Arrhythmias
An arrhythmia is a disorder of the heart rate (pulse) or heart rhythm. The heart can beat too fast (tachycardia), too slow (bradycardia), or irregul...
Heart failure
Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...
Pulmonary edema
Pulmonary edema is an abnormal buildup of fluid in the lungs. This buildup of fluid leads to shortness of breath.
When to Contact a Medical Professional
This is an emergency condition. Call 911 or the local emergency number if you have hyperthyroidism and experience symptoms of thyroid storm.
Prevention
To prevent thyroid storm, hyperthyroidism should be treated.
References
Hollenberg A, Wiersinga WM. Hyperthyroid disorders. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 12.
Pearce EN, Hollenberg AN. Thyroid. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 207.
Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 117.
Weetman AP, Kahaly GJ. Graves disease. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 71.
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Thyroid gland - illustration
The thyroid gland, a part of the endocrine (hormone) system, plays a major role in regulating the body's metabolism.
Thyroid gland
illustration
Review Date: 2/28/2024
Reviewed By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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