Thyroid Storm

Ari Sacks MD

The Common Vein Copyright 2010


Thyroid storm, also known as thyrotoxicosis, is a life threatening hypermetabolic state due to massive release of thyroid hormones (T3 and T4) into the circulation.

Thyrotoxicosis can be caused by several mechanisms including thyroid surgery, infection, trauma, or large iodine load. Occasionally thyroid storm may be caused by long standing untreated hyperthyroid states, such as Grave’s Disease.

The result of the large levels of active free thyroid hormones is an exaggerated form of hyperthyroidism that can be life threatening.

Structural changes depend on the cause of the thyrotoxicosis, and function changes are either the increased production or massive release of thyroid hormones into the blood stream.

Clinically patients may present with fever, tachycardia, hypertension, diarrhea, and delirium. If left untreated, thyroid storm can eventually lead to arrhythmias, CHF, seizures and/or death.

Imaging modalities are not typically used to diagnose thyroid storm.

Laboratory studies showing high levels of thyroid hormones in the blood stream, along with the clinical scenario of a hypermetabolic state is the best way to diagnose thyroid storm.

Treatment of thyroid storm consists of aggressive treatment of life threatening symptomatology such as CHF, seizures, and/or hyperthermia. Adrenergic blocking medications, such a propanolol, are very helpful for treating the cardiac sequelae. Additionally PTU or methimazole should be used to decrease the amount of thyroid hormone being produced.