SUN-555 Clinical Outcomes of Thyroid Storm at Kurashiki Central Hospital: Effectiveness of Clinical Criteria and Severity Scores

Abstract

BACKGROUND: Thyroid storm (TS) is a life-threatening condition requiring emergency treatment. The reported mortality of TS is 10-20%, but there have not been many large clinical studies regarding the severity and prognosis of TS. The 2017 Guidelines for the Management of Thyroid Storm (The Japan Thyroid Association (JTA) and The Japan Endocrine Society) indicate that there is a significant correlation between TS mortality and the Acute Physiology and Chronic Health Evaluation (APACHE II) score (Odds ratio: 1.15), as well as between TS mortality and the Sequential Organ Failure Assessment (SOFA) score (Odds ratio: 1.33). In this report, we examined which severity score is a prognostic predictor of TS severity, in a comparison between the JTA score and the Burch-Wartofsky point scale (BWPS). CLINICAL CASES: In a retrospective chart review of patients diagnosed and treated at the Kurashiki Central Hospital (Kurashiki City, Japan) from 2005 to 2017, 3361 patients were diagnosed with Graves' disease, but only 5 developed TS (0.14%). TS was defined using the JTA and BWPS criteria; based on the use of either diagnostic criteria, the diagnosis of TS did not differ. Its severity was defined using the SOFA and APACHE II scores. The median age was 56 years [49-77 years]; females comprised 3 of the 5 patients (60%). Only 1 patient experienced a fatal case of TS. All 5 cases met the JTA criteria for definite diagnosis of TS; the median BWPS score was 80 points [55-85 points]. The median SOFA score was 3 points [0-5 points] and the media APACHE II score was 16 points [10-20 points]. The APACHE II score of the fatal case was 20 points, which was the highest among all 5 cases. Among the surviving cases, the periods of treatment in the Intensive Care Unit was less than 3 days. All survival cases were treated with antithyroid drugs, β-blockers, glucocorticoids, and acetaminophen. None of the patients in our report underwent hemodialysis. The APACHE II score is an accurate measure of severity of illness that correlates strongly with patient outcome. In our analysis, there was no difference between the survival cases and the fatal case, with respect to the JTA and BWPS criteria, or the SOFA score. However, the APACHE II score of the fatal case was higher than that of the survival cases. Notably, Aa-DO2/PaO2, arterial blood pH/venous blood HCO3-, and Glasgow Coma Scale were the major factors associated with mortality. CONCLUSION: Our data suggested that there was no difference in the diagnosis of TS, based on the diagnostic criteria of JTA and BWPS. The APACHE II score was helped to estimate the severity of multiple organ dysfunction of TS.