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Thyroid storm

Thyroid storm is a very rare, but life-threatening condition of the thyroid gland that develops in cases of untreated thyrotoxicosis (hyperthyroidism, or overactive thyroid).

The thyroid gland is located in the neck, just above where your collarbones meet in the middle.

Causes

Thyroid storm occurs due to a major stress such as trauma, heart attack, or infection. In rare cases, thyroid storm can be caused by treatment of hyperthyroidism with radioiodine therapy.

Symptoms

Symptoms are severe and may include any of the following:

Exams and Tests

The health care provider may suspect thyrotoxic storm based on:

  • A high systolic (top number) blood pressure reading and a low diastolic (bottom number) blood pressure reading may be low
  • An increased heart rate

Blood tests are done to check thyroid hormones TSH, free T4 and T3.

Other blood tests are done to check heart and kidney functions and to check for infection.

Treatment

Less severe forms of thyroid storm can be managed well with supportive measures, such as giving oxygen and fluids in case of difficult breathing or dehydration. Treatment may include any of the following:

  • Cooling blankets to return the body temperature to normal
  • Monitoring any excess fluid in older people with heart or kidney disease
  • Medicines to manage agitation
  • Vitamins and glucose

The final goal of treatment is to decrease the levels of thyroid hormones in the blood. Sometimes, iodine or other drugs may be given to lower the hormone level in the blood.

Antibiotics are given in case of infection.

Possible Complications

Irregular heart rhythms (arrhythmias) may occur. Heart failure and pulmonary edema can develop rapidly and cause death.

When to Contact a Medical Professional

This is an emergency condition. Call 911 or another emergency number if you have hyperthyroidism and experience symptoms of thyroid storm.

Prevention

To prevent thyroid storm, hyperthyroidism should be treated.

Alternative Names

Thyrotoxic storm; Hyperthyroid storm; Accelerated hyperthyroidism; Thyroid crisis; Thyrotoxicosis - thyroid storm

References

Ferri FF. Thyrotoxic storm. In: Ferri FF, ed. Ferri's Clinical Advisor 2016. Philadelphia, PA: Elsevier; 2016:1223.e3-1223.e3.

Marino M, Vitti P, Chiovato L. Grave's disease. In: Jameson JL, De Groot LJ, de Krester DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 82.

Sharma AN, Levy DL. Thyroid and adrenal disorders. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 128.

Review Date 2/3/2016

Updated by: Brent Wisse, MD, Associate Professor of Medicine, Division of Metabolism, Endocrinology & Nutrition, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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