Thyroid storm – what you should know

Many of us may have no clue of a potentially life-threatening condition that may occur if hyperthyroidism is left untreated or undertreated.  This condition is called thyroid storm and individuals not being treated for an overactive thyroid can be at risk for this rare phenomenon.   

What causes a thyroid storm?

Thyroid storm is when the thyroid gland, located at the base of the neck, suddenly releases large amounts of thyroid hormone in a short period of time.  A person’s systolic blood pressure (top number when the heart is contracting) may rise, while their diastolic (bottom number or when the heart is between beats) plummets.  Heartbeat will speed up causing difficulty in breathing and yellowing of the skin. 

Emergency medical attention is required to avoid suffering from multiple organ failure, heart failure, or other related causes.

This condition is more likely to develop when a person has a serious health problem in addition to hyperthyroidism or in people who have untreated or undertreated Grave’s disease. 

A thyroid storm has a greater likelihood of happening during or after a stressful event such as trauma or a serious illness such as a major infection.  It may also be triggered by surgery or by using iodine for a CT scan or in radioactive iodine therapy.

What are the symptoms?

Typically in someone experiencing thyroid storm there will be an exaggeration of the body’s usual response seen in hyperthyroidism with patients abruptly experiencing multi-system involvement.  The three main symptoms include:

·      An elevated body temperature – this could be as high as 105 degrees Fahrenheit or 41 degrees Celsius

·      Palpitations

·      Changes in mental status such as anxiety or confusion

Other symptoms that may occur can include the following:

·      Chest pain

·      Breathing difficulties

·      Fatigue

·      Sweating

·      Heat intolerance

·      Abdominal pain

·      Tremors

·      Vomiting

·      Diarrhea

·      Yellowing of the skin and eyes (jaundice)

·      High blood pressure

Anyone having any of the above symptoms and are unable to function normally should be taken to an emergency room immediately or call 911.  Mortality rates can be as high as 20-30% with most patients dying from congestive heart failure.

There are no specific lab tests to confirm a diagnosis of thyroid storm.  Since a thyroid storm is a very dangerous condition, there is often no time for blood tests as medical treatment is needed to be started immediately.  If there is any time for tests, confirmation of the following can help diagnosis what is going on -  disturbed electrolyte levels, raised liver enzyme levels, extremely high thyroid hormone levels, and signs of shock with a raised pulse and low blood pressure.

Treating thyroid storm

To treat thyroid storm saving a person’s life consists of life support measures to support vital organ function along with attempts to reduce thyroid hormone release.  A thorough evaluation to determine the cause of thyroid storm must be carried out along with treatment of underlying or precipitating diseases or conditions. 

Treatment along with supportive measures may include use of intravenous fluids and electrolytes, oxygen if needed, fever control, iodide to block thyroid hormone release, and drugs called beta blockers to block the action of thyroid hormones on the body.

After thyroid storm

Patients surviving a thyroid storm will need to be carefully monitored in the intensive care unit.  Once released from the hospital, it will be very important they follow-up with their doctor to monitor their thyroid gland and to formulate a treatment plan for hyperthyroidism and learning the warning signs to prevent it from happening again. 

It is vital anyone with hyperthyroidism always takes their medication to treat it as prescribed and to not stop taking medication until they have been evaluated by their doctor.