Severe Thyrotoxicosis and Thyroid Storm

Abstract

Thyroid storm is a syndrome of clinical decompensation in a patient with thyrotoxicosis and is counted among the endocrine emergencies due to its high morbidity and mortality. Thyroid storm is a clinical diagnosis, traditionally recognized as a syndrome involving thyrotoxicosis, hyperthermia, altered mentation, and a precipitating event. While laboratory information can be helpful in the evaluation of patients, there is no test that confirms or excludes the diagnosis of thyroid storm. The treatment of thyroid storm should be initiated as early as possible after clinical recognition of the diagnosis. The essential elements in the treatment of thyroid storm involve (1) intensive supportive care, (2) decreasing β-adrenergic receptor stimulation, (3) decreasing thyroid hormone production and release from the thyroid gland, (4) decreasing peripheral availability of thyroid hormones, and (5) providing treatment for acute concurrent illnesses. This chapter provides a concise summary of the clinical assessment of patients with thyrotoxicosis and focuses on clinical features, diagnosis, and management of severe thyrotoxicosis and thyroid storm.