Thyroid Storm
OVERVIEW
- life threatening exacerbation of hyperthyroid state with 1 or more organ dysfunction
CLINICAL FEATURES
- may occur 6-24 hours post surgery
- fever
- sweating
- HR >140/min
- coma
- nausea and vomiting
- diarrhoea
MANAGEMENT
Supportive
- IVF (glucose)
- cooling cares
- paracetamol (no NSAIDs or aspirin -> displaces thyroxine from proteins)
- propanolol increments (1mg IV) or esmolol boluses -> infusion (50-100mcg/kg/min)
Specific
- hydrocortisone 200mg IV QID (adrenal insufficiency + decreases T4 release and conversion)
- propylthiouracil (1g load PO -> 250mg QID to inhibit thyroid hormone release and decrease peripheral conversion from T4-T3)
- after blockade by propylthiouracil give sodium iodide or potassium iodide or Lugol’s iodine
References and Links
Journal articles
- Bello G, Ceaichisciuc I, Silva S, Antonelli M. The role of thyroid dysfunction in the critically ill: a review of the literature. Minerva Anestesiol. 2010 Nov;76(11):919-28. PMID: 20935602.
- Carroll R, Matfin G. Endocrine and metabolic emergencies: thyroid storm. Ther Adv Endocrinol Metab. 2010 Jun;1(3):139-45. PMC3475282.
- Muller C, Perrin P, Faller B, Richter S, Chantrel F. Role of plasma exchange in the thyroid storm. Ther Apher Dial. 2011 Dec;15(6):522-31. PMID: 22107688.
FOAM and web resources
- ALIEM — Diagnosing hyperthyroidism: Answers to 7 common questions (2013)
- ALIEM — Thyroid Storm: Treatment Strategies (2013)
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC