The article provides a straightforward overview of the causes, symptoms, diagnosis, treatment, and prevention of thyroid storm, also known as thyrotoxic crisis.
Causes:
Individuals with underlying hyperthyroidism are more likely to suffer from thyroid storms, which can be triggered by various factors such as:
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Untreated or inadequately controlled hyperthyroidism: Individuals with pre-existing hyperthyroidism can become susceptible to thyroid storms if thyroid hormone levels are not managed or regulated.
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Thyroid storms are precipitated by acute stressors such as trauma, surgery, infection, childbirth, or emotional stress.
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Certain medications, such as iodinated contrast agents, amiodarone, and thyroid hormone supplements, can exacerbate hyperthyroidism and increase thyroid storm risk.
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Surgery or radioiodine therapy for hyperthyroidism can cause an abrupt release of thyroid hormones and precipitate thyroid storm in susceptible individuals.
Symptoms:
There are a number of symptoms associated with thyroid storm, including:
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There is a high fever, often exceeding 102°F (38.9°C), accompanied by profuse sweating and heat intolerance.
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An elevated heart rate (tachycardia) and palpitations, over 140 beats per minute (bpm) in severe cases, can result in increased cardiac output and arrhythmia risk.
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Blood pressure is elevated due to sympathetic nervous system activity and peripheral vascular resistance, often exceeding 160/90 mmHg.
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A high level of thyroid hormone can cause agitation, confusion, delirium, or psychosis in the central nervous system.
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A hypermetabolic state and increased gastrointestinal motility may cause nausea, vomiting, diarrhea, or abdominal pain.
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An increased sympathetic nervous system activity may result in fine tremors of the hands or extremities.
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Graves' disease, a common cause of thyroid storms, can cause protrusion or bulging of the eyes (exophthalmos).
Diagnosis:
A thyroid storm is diagnosed based on clinical evaluation and recognition of characteristic symptoms. Diagnostic criteria may include:
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The Burch-Wartofsky Point Scale is used to determine the severity of thyrotoxicosis and diagnose thyroid storm based on clinical features such as temperature, heart rate, central nervous system symptoms, and gastrointestinal symptoms.
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Performing blood tests to measure thyroid hormone levels (e.g., free thyroxine [T4], triiodothyronine [T3], thyroid-stimulating hormone [TSH]) and assess symptoms of thyrotoxicosis.
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Thyroid ultrasound or radioactive iodine uptake scans can be used to evaluate thyroid gland size, vascularity, and function.
Treatment:
To stabilize thyroid hormone levels, control symptoms, and prevent life-threatening complications, thyroid storm requires prompt and aggressive treatment. Treatment strategies include:
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Medications such as propranolol and esmolol can block the effects of thyroid hormones on the cardiovascular system and alleviate symptoms such as hypertension and tachycardia.
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Methimazole and propylthiouracil (PTU) inhibit thyroid hormone synthesis and reduce thyroid hormone levels.
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To block thyroid hormone release and reduce thyroid gland vascularity, potassium iodide or Lugol's solution may be administered.
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Inhibiting peripheral conversion of T4 to T3 and reducing thyroid hormone activity can be achieved with intravenous corticosteroids such as hydrocortisone.
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In order to manage dehydration, electrolyte imbalances, and organ dysfunction, intravenous fluids, electrolyte replacement, and supportive measures such as cooling blankets or mechanical ventilation may be necessary.
Prevention:
Identifying and managing underlying hyperthyroidism and precipitating factors, as well as:
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To prevent exacerbations or complications of hyperthyroidism, individuals with hyperthyroidism should have regular medical follow-ups to monitor thyroid hormone levels, symptoms, and response to treatment.
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The prevention of thyroid storms can be achieved by adhering to prescribed antithyroid medications and avoiding potential triggers such as iodinated contrast agents or certain medications.
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Individuals who are susceptible to thyroid storm can reduce their risk by minimizing exposure to acute stressors such as infection, trauma, and emotional stress.
