|Classification and external resources|
Thyroid storm or thyrotoxic crisis is a rare but severe and potentially life-threatening complication of hyperthyroidism (overactivity of the thyroid gland). It is characterized by a high fever (often above 40 °C/104 °F), fast and often irregular heart beat, vomiting, diarrhea, and agitation. Heart failure may occur, and myocardial infarction is encountered. Death may occur despite treatment. Most episodes occur either in those with known hyperthyroidism whose treatment has been stopped or become ineffective, or in those with untreated mild hyperthyroidism who have developed an intercurrent illness (such as an infection).
The causes of thyroid storm are multifactorial. Elevated iodothyronine concentrations are only one of many components. Rather, the transition from thyrotoxicosis to thyroid storm is ignited by non-thyroidal triggers including, but not limited to fever, sepsis, dehydration, myocardial infarction and psychiatric diseases.
According to newer theories thyroid storm results from allostatic failure in a situation were thyrotoxicosis hampers the development of non-thyroidal illness syndrome, which would help to save energy in situations of high metabolic demand
The probability of thyroid storm in the context of thyrotoxicosis can be assessed with the Burch-Wartofsky score, first introduced in 1993. A score is derived from various clinical parameters (such as temperature, heart rate and severity of agitation); a score below 25 signals unlikely thyroid storm, 25–45 suggests impending storm, and above 45 is suggestive of thyroid storm.. Alternatively, the Akamizu criteria, derived from a large cohort of patients with thyroid storm in Japan, provides a similar scale to assess the probability of thyroid storm.
Thyroid storm requires prompt treatment and hospitalization. Often, admission to the intensive care unit is needed. Inorganic iodide (ideally potassium iodide and not Lugol's iodine) and antithyroid drugs (propylthiouracil or methimazole) are used to reduce the release of thyroid hormone from the gland, and beta blockers (e.g. propranolol) to reduce the effect of circulating thyroid hormone on end organs. Corticosteroids, like dexamethasone, are used to prevent peripheral conversion of T4 to T3. In high fever, temperature control is achieved with paracetamol/acetaminophen, frequent fluid replacement, mechanical ventilation and corticosteroids. Any suspected underlying cause is also addressed.
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