Thyroid storm is a life-threatening, severe physiologic reaction to uncontrolled hyperthyroidism.
- Triggers
- Surgery – thyroid hormone levels should be normalized before surgery
- Anaesthesia – even simple induction can cause a thyrotoxic storm
- Radioactive Iodine
- Infection
- Childbirth
- Signs and symptoms
- Severe hyperthyroidism
- Hyperthermia
- Agitation
- Confusion
- Coma (rarely)
- Tachycardia > 140 bpm
- Atrial fibrillation
- Heart failure
- Vomiting
- Acute abdomen
- Treatment
- IV fluid resuscitation
- Nasogastric tube
- Sedation if necessary
- Paracetamol for fever
- NSAIDs or aspirin may desiplace thyroxine from proteins
- Caridac monitoring
- Propranolol to control symptoms of hyperthyroidism
- IV esmlol (ultra-short acting beta blocker) can be used in patients with asthma
- Dilitiazem can be used if beta blockers are contraindicated
- High-dose digxin may be used to slow the heart
- Hydrocortosone to decrease T4 release and peripheral conversion, and for adrenal insufficiency
- Propylthiouracil to decrease T4 release and peripheral conversion
- Lugol’s solution after blockade by propylthiouracil
- Treat suspected infection