Thyroid Storm

Thyroid Storm – Gaby Schroeder

Background

  • Diagnosis: based on recognition of exaggerated signs/symptoms of thyrotoxicosis leading to multi-organ dysfunction in the setting of precipitating event
  • Common Precipitants: Grave’s Disease, Surgery, Trauma, Pregnancy, stress, Infection, MI/PE, medication non-compliance, iodine loads
  • Use Burch-Wartofsky Point Scale (BWPS); available on MD Calc
    • >45 highly suggestive
    • 25-44 impending storm
    • <25 unlikely to represent storm

 

Management

  • ENDOCRINE EMERGENCY, if suspected should get Endocrine Consult ASAP
  • Therapies directed towards thyroid gland:
    • PTU: Preferred, 500-1000mg loading dose, followed by 250mg q4 -6 hours (PO, rectal)
    • Methimazole: q4-6 hours, dose varies (PO, rectal, IV)
  • Therapies directed toward decreasing T4 to T3 conversion:
    • Propranolol (60-80mg PO q4)
    • Hydrocortisone (300mg x1, 100mg q8)
      • Treats high incidence of co-existing adrenal insufficiency
  • Cholestyramine 4g QID can be considered to reduce enteric recirculation
  • Refractory Storm: Plasmapheresis and Plasma Exchange
  • Supportive care and identify precipitating factor
  • Close hemodynamic monitoring, may need vasopressors (likely ICU)