Thyroid storm also known as thyrotoxic crisis is a rare but life-threatening condition of hypermetabolic state induced by excessive release of thyroid hormones (THs) in individuals with thyrotoxicosis.
Mortality rate is up to 30% even with treatment.
Causes of death include cardiac failure, arrythmias and hyperthermia
Precipitants of thyroid storm (thyrotoxic crisis) include the following:
- Trauma & Surgery
- Diabetic ketoacidosis
- Radio iodine treatment of patients with partially treated or untreated hyperthyroidism
Clinical features of thyroid storm (thyrotoxic crisis)
Complications of thyroid storm (thyrotoxic crisis)
The complications of thyroid storm (thyrotoxic crisis) are:
- Cardiac failure
- Diagnosis is mainly clinical and laboratory investigations are done to identify possible precipitants-infection.
- Level of thyroid hormones may not be markedly elevated.
- Correlation does not exist between levels of thyroid hormones and thyroid storm.
- FBC may show leucocytosis even in the absence of infection
- Raised bilirubin,
- Alkaline phosphatase
- The management of thyroid storm (thyrotoxic crisis) requires intensive monitoring
- Supportive care
- Identification and treatment of precipitating cause(s)
- Reduction in T synthesis/action and
restoration to normal values
- Treatment of identified precipitating factors
- Prevention of complications
Adult: 600 mg loading dose; 200 – 300 mg orally every 6 hours by nasogastric tube or per rectum
- 5-12 years: Initially 50 mg orally 3 times daily until euthyroid then adjusted as
- 12 18 years. Initially 100 mg 8 hourly daily administered until euthyroid then adjusted as necessary; higher doses
Saturated Solution of Potassium lodide
Adult: 5 drops every 6 hours; to be
commenced 1 hour after the first dose of propylthiouracil
- 1 month -1 year: 0.2 – 0.3 mL orally 8 hourly daily.
- Dilute well with milk and water
Adult: 40-60 mg orally every 4 hours or 2 mg intravenously every 4 hours
- Neonate, initially 250-500 μg/kg every 6 -8 hours, adjusted according to response
- 1 month – 18 years: initially 250-500 μg/kg every 6 – 8 hours, adjusted according to response; doses up to 1 mg/kg may be required; maximum 40 mg every 8 hours
- 2 mg intravenously every 6 hours
Intravenous Chlorpromazine 50-100mg.
- Intramuscular route to treat agitation
- Used if arrhythmia is present; choice of drug depends on arrhythmia type.
- (if infection is present)
- Adequate hydration with intravenous fluids and cooling