Thyrotoxic Crisis: Thyroid Storm

Thyroid Storm (Thyrotoxic Crisis)

The Thyroid and Its Diseases ◽

10.1007/978-3-319-72102-6_25 ◽

2019 ◽

pp. 357-366 ◽

Cited By ~ 1

Author(s):

Leonard Wartofsky ◽

Joanna Klubo-Gwiezdzinska

Keyword(s):

Thyroid Storm ◽

Thyrotoxic Crisis

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Thyrotoxic Crisis: Thyroid Storm

Contemporary Endocrinology - Endocrine Emergencies ◽

10.1007/978-3-030-67455-7_9 ◽

2021 ◽

pp. 71-92

Author(s):

John J. Reyes-Castano ◽

Kenneth Burman

Keyword(s):

Thyroid Storm ◽

Thyrotoxic Crisis

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Thyroid Storm Induced by Blunt Thyroid Gland Trauma

The American Surgeon ◽

10.1177/000313480707301211 ◽

2007 ◽

Vol 73 (12) ◽

pp. 1247-1249 ◽

Cited By ~ 7

Author(s):

Stylianos Delikoukos ◽

Fotios Mantzos

Keyword(s):

Thyroid Gland ◽

Clinical Findings ◽

Uneventful Recovery ◽

Thyroid Storm ◽

Neck Trauma ◽

Blunt Neck Trauma ◽

Acute Airway Obstruction ◽

Thyrotoxic Crisis ◽

Life Threatening ◽

Left Lobectomy

Isolated thyroid gland injury due to blunt neck trauma is uncommon and rarely complicated by thyroid storm in patients without known hyperthyroidism. The aim of this study was to report our experience on blunt thyroid gland injury followed by massive gland hemorrhage, acute airway obstruction, and symptoms of thyroid storm. Among 231 patients with neck trauma, four patients appeared with isolated thyroid gland injury. In two of them, the diagnosis of simultaneous thyrotoxic crisis was made on the basis of clinical findings and confirmed on emergency laboratory tests. The diagnosis of thyroid gland injury was supposed by the history and physical examination and established after neck exploration. Therapy was directed at stabilizing the patients by correcting the hyperthyroid state, followed by operative treatment. Left lobectomy and total thyroidectomy were performed and, along with postoperative medical measures, led to uneventful recovery. This study demonstrates that thyroid gland injury due to blunt neck trauma, although uncommon, may result in potentially life-threatening thyroid storm due to rupture of acini and liberation of thyroid hormones into the bloodstream. This may occur in patients without known hyperthyroidism.

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Plasmapheresis as an Effective Treatment for Thyroid Storm in Critical Patients: Case Reports and Systematic Literature Review

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1936 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A947-A948

Author(s):

Vanessa Cherniauskas ◽

Andre Laffranchi Santos ◽

Danielle Daffre Carvalho ◽

Maria Cristina Albe Olivato ◽

Rosalia de Prado Padovani ◽

...

Keyword(s):

Case Reports ◽

Trigger Factor ◽

Definitive Treatment ◽

Thyroid Storm ◽

Antithyroid Drugs ◽

Free T4 ◽

Treatment Type ◽

Initial Symptoms ◽

Thyrotoxic Crisis ◽

Organ Dysfunctions

Abstract Background: Thyrotoxic crisis is a rare, multisystemic and lethal condition, especially when its reversal is delayed. The Burch Wartofsky score establishes severity and predicts the indication of plasmapheresis, but once there is organ dysfunction this therapy should be considered despite of the score. When it is added to conventional treatments it is really effective because of the quick clinical compensation of critically ill patients regardless of the main trigger factor of this emergency. Clinical Cases: 5 patients with thyrotoxic crisis, 1 man and 4 women that had Graves’disease (4 cases) or TSH-secreting tumor (1 case). The precipitating factors were: 1 case due to orchitis, 2 due to poor adhesion, 1 due to antithyroid drugs hepatoxicity and 1 due to ketoacidosis. All them had elevated free T4 ranging from 3.38 to >7.77 ng/dL. All them had high Burch Wartofsky scores (55 to 70) and severe organ dysfunctions: 4 cases with hepatopathy (hepatosplenomegaly, jaundice and coagulopathy) and cardiopathy (diastolic dysfunction and pulmonary hypertension) and 1 case with severe diabetic ketoacidosis. Plasmapheresis (2 to 3 sessions were performed) were indicated for clinical compensation and so subsequent definitive treatment: 3 cases received radioiodine therapy and 1 case had total thyroidectomy. All of them progressed well. The patient who died had already severe prior comorbidities. We performed a systematic survey on PubMed of English articles (case reports and reviews) in humans and we analyzed our 5 cases along with the 108 articles about the use of plasmapheresis in thyroid storm from 1970 to 2020 and we compare them to 394 ones of conventional treatments in past 10 years. Our objective was to evidence plasmapheresis is not related to a higher mortality of patients who underwent to it. We found 7% of mortality in both groups. The chi square test showed an Odds Ratio of (CI 95%) = 1,091 reinforcing there is no relation between number of deaths and treatment type. Conclusion: Plasmapheresis is a therapeutic option with few reports in the literature and without clear guidelines about indication criteria or better timing to initiate it. The statistical analysis showed that 3 or more organ dysfunctions in thyroid storm are related to higher death rates. Its early employment within 24 hours of the initial symptoms and the prompt normalization of free T4 are related to lower mortality. It is a safe and effective therapy that allows thyroid storm patients to be compensated to receive definitive treatment with lower chances of death. Reference: Ono Y, Ono S, Yasunaga H, Matsui H, Fushimi K, Tanaka Y. Factors Associated With Mortality of Thyroid Storm: Analysis Using a National Inpatient Database in Japan. Medicine (Baltimore). 2016;95(7):e2848.

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Propranolol-Induced Circulatory Collapse in a Patient With Thyroid Crisis and Underlying Thyrocardiac Disease: A Word of Caution

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709617747903 ◽

2017 ◽

Vol 5 (4) ◽

pp. 232470961774790 ◽

Cited By ~ 2

Author(s):

Hossam Abubakar ◽

Vijendra Singh ◽

Anandita Arora ◽

Sammar Alsunaid

Keyword(s):

Adverse Outcome ◽

Active Form ◽

Severe Form ◽

Thyroid Storm ◽

Adrenergic Blockade ◽

Suitable Alternative ◽

Thyrotoxic Crisis ◽

Life Threatening ◽

Long Acting ◽

Peripheral Conversion

Thyrotoxic crisis or thyroid storm is a severe form of hyperthyroidism and a rare endocrinological emergency. The cornerstones of medical therapy in thyroid storm include decreasing the levels of circulating T3 in the blood as well as inhibiting the hormone’s peripheral effects through β-adrenergic blockade. Propranolol is the preferred agent for β-blockade in hyperthyroidism and thyroid storm due to its additional effect of blocking the peripheral conversion of inactive T4 to active form T3. We report a typical clinical scenario where propranolol was administered in treatment of thyroid storm but an uncommon adverse outcome: circulatory failure from cardiogenic shock warranting vasopressor and inotropic support. Caution with regard to the use long-acting β-blocking agents in patients with underling thyrocardiac disease may prevent this life-threatening adverse effect. Ultra–short-acting β-blockers that are easy to titrate maybe a suitable alternative in this subset of patients.

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Diabetic ketoacidosis and thyroid storm: coexistence of a double trouble

BMJ Case Reports ◽

10.1136/bcr-2018-225748 ◽

2018 ◽

pp. bcr-2018-225748

Author(s):

Rajesh Rajput ◽

Deepak Jain ◽

Vaibhav Pathak ◽

Anoop Dangi

Keyword(s):

Diabetic Ketoacidosis ◽

Thyroid Storm ◽

Thyrotoxic Crisis

Diabetic ketoacidosis (DKA) and thyrotoxic crisis are both endocrine emergencies. Here, we present a case of a patient who presented with DKA and on further evaluation was found to also have a thyrotoxic crisis. The coexistence of both of these endocrine emergencies simultaneously is extremely rare and heralds grave prognosis unless identified and treated promptly.

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