Thyroid Storm in Head and Neck Emergency Patients.

Basaviah Natesh,Jonathan Hughes,Raghav C Dwivedi,Francis Vaz,Paul Stimpson,Mohamed A Radhi

doi:10.3390/jcm9113548

Abstract

Background: Thyroid storm is a rare but life-threatening emergency that prompts urgent intervention to halt its potentially disastrous outcomes. There is not much literature available on thyroid storm in head neck trauma and non-thyroid/parathyroid head neck surgery. Due to rarity of thyroid storm in head and neck trauma/surgery patients, its diagnosis becomes challenging, is often misdiagnosed and causes delay in the diagnosis and management. Therefore, the aim of this work was to compile, analyze and present details to develop a consensus and augment available literature on thyroid storm in this group of patients. Materials and methods: A comprehensive literature search of the last 30 years was performed on PUBMED/MEDLINE, EMBASE, CINAHL and Science Citation Index for thyroid storm using MeSH words and statistical analyses were performed. Results: Seven articles describing seven cases of thyroid storm were reviewed. All patients required medical management and one patient (14.3%) required adjunctive surgical management. Burch and Wartofsky Diagnostic criteria for thyroid storm were used in diagnosis of 42% patients. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation. It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality. Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient.

Highlights

Thyroid storm (TS) or crisis is defined as an acute, decompensated state of thyroid hormone–induced, severe hypermetabolism involving multiple systems and is the most extreme state of thyrotoxicosis
Since the number of studies published on thyroid storm in non-thyroid/parathyroid head and neck patients is small, a proper meta-analysis was not possible
Causes of trauma ranged from assault (3 patients = 42.8%) to road traffic accidents, suicide attempts by hanging and accidental self-inflicted injury (1 patient = 14.3% in each category respectively)

Summary

Introduction

Thyroid storm (TS) or crisis is defined as an acute, decompensated state of thyroid hormone–induced, severe hypermetabolism involving multiple systems and is the most extreme state of thyrotoxicosis. Based on national surveys from the United States the incidence of thyroid storm is 0.57 to 0.76 in 100,000 persons per year in patients ≥ 18 years of age with the mean age ± SE of 48.7 ± 0.11 years It is more common in females as compared to males with the M: F of 1:3 and in-hospital mortality rates of 1.2–3.6% [2]. Time of diagnosis varied from immediately upon presentation to formulating a retrospective diagnosis of having a full-blown thyroid storm at 4 days post presentation It was misdiagnosed and unthought of initially in majority of these cases, (71.4%) were not diagnosed in the first day of hospital stay. Conclusion: Early recognition of thyroid storm in head and neck patients markedly reduce morbidity/mortality Albeit unexpected, it should be ruled out in any symptomatic head and neck trauma or post-surgery patient

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Conclusion