6973 Prospective Multicenter Registry-Based Study on Thyroid Storm: The 2016 Guidelines for the Management from the Japan Thyroid Association and Japan Endocrine Society Are Useful

Abstract

Abstract Disclosure: Y. Furukawa: None. K. Tanaka: None. O. Isozaki: None. A. Suzuki: None. T. Iburi: None. K. Tsuboi: None. M. Iguchi: None. N. Kanamoto: None. K. Minamitani: None. S. Wakino: None. T. Satoh: None. S. Teramukai: None. E. Kimura: None. Y. Miyake: None. T. Akamizu: None. Context: The mortality rate in thyroid storm (TS) has been reported to be higher than 10%. Even when patients survive, some have irreversible damages. In order to improve the prognosis of patients with TS, appropriate management as well as prompt and accurate diagnosis are needed. We created the diagnostic criteria in 2012 and established guidelines for the management of TS in 2016. Objective: We aimed to evaluate the effectiveness of the 2016 guidelines for the management of TS proposed by the Japan Thyroid Association and Japan Endocrine Society. Design: Prospective registry-based study through a secure web platform. Setting: Prospective multicenter registry. Patients and Measurements: Patients with new-onset TS were registered in the Research Electronic Data Capture (REDCap) from May 1, 2018 to April 30, 2022, over four years. On day 30 after admission, clinical information and prognosis of each patient were added to the platform. On day 180, the prognosis was described. The questionnaire consisted of 176 items totally. Results: This study included 110 patients with TS (93 definite and 17 suspected). The median of Acute Physiology and Chronic Health Evaluation (APACHE) II score was 13, higher than the score in the previous nationwide survey, 10 (p=0.001). Nonetheless, the mortality rate at day 30 was 5.5%, approximately half compared with 10.7% in the previous nationwide survey (p=0.13). Lower BMI, lower left ventricular ejection fraction (LVEF) and shock were positively associated with poor prognosis at day 30. The lack of fever ≥ 38°C was surprisingly associated to the outcome. Approximately 80% of doctors followed the guidelines. The mortality rate in patients with an APACHE II score ≥ 12 for whom the guidelines were not followed was significantly higher than the rate in patients for whom the guidelines were followed (50% vs. 4.7%) (p=0.01). Conclusions: Prognosis seemed better than in the previous nationwide survey, even though disease severity was higher. The mortality rate was lower when the guidelines were followed. Thus, the guidelines are useful for managing TS. Presentation: 6/2/2024