Incidence, Management, and Outcomes of Acute Liver Failure Secondary to Thyroid Storm in the United States

Abstract

Introduction: Thyroid storm (TS) accounts for approximately 1-2% of admissions for thyrotoxicosis. In these patients liver dysfunction can result from hepatic congestion, hypoperfusion, or direct effect from the hyperthyroidism. While the pathophysiology for this has been described in small case series, the epidemiology and outcomes of acute liver failure (ALF) is described only in small case series and large nationally representative data is lacking. Methods: We queried the National Inpatient Sample database for patients with the discharge diagnosis of thyroid storm from 2003 to 2011. Results: We identified a total of 42,765 patients with a discharge diagnosis of TS. The overall incidence of ALF was 1.3% with a rise in incidence from 0.3% in 2003 to 3.7% in 2011. This increase was independent of sex, race and a dichotomized age of 65 years. Patients with ALF were more likely to be younger (p=0.001), men (p < 0.001), alcoholic (p=0.002) and have pre-existing iron deficiency anemia, congestive heart failure, coagulopathy, chronic liver disease, electrolyte disturbances, psychoses and renal failure (p < 0.001 for all). 8.1% of patients with ALF developed hepatic encephalopathy and mortality was high at 34.5%. However, mortality has decreased from 46.9% in 2003 to 27.4% in 2011 (p=0.005). 8.1% of patients received liver transplantation during their hospital stay and mean duration of hospitalization was 17.4 ±18.7 days Conclusion: While incidence of ALF is increasing, mortality from this condition has reduced significantly from 2003 to 2011.Figure 1