Thyroid Storm


Last Updated December 20th, 2021

Thyroid Storm: What is it?

Thyroid storm is a case of untreated or undertreated hyperthyroidism that is life-threatening. It is associated with rapid heartbeat rate and high blood pressure and temperature. If prompt treatment is not provided, thyroid storm is fatal.

The thyroid is a butterfly-shaped gland located in the middle part of the lower neck. It secretes two hormones triiodothyronine (T3) and thyroxine (T4). When the thyroid gland secretes too much of these two hormones, it is called hyperthyroidism. This medical condition causes all of your cells to work quickly. For example, your rate of respiration and your heartbeat rate will be higher. You may even have a tendency to talk faster than you normally do.

Causes of Thyroid Storm

Being a condition that affects only those with hyperthyroidism who do not receive appropriate care, thyroid storm is very rare. Extreme overproduction of the two hormones secreted by the thyroid gland is what leads to this. Causes of this condition include:

  • Severe undertreated case of hyperthyroidism
  • Infection associated with hyperthyroidism
  • Untreated overactive thyroid

People with hyperthyroidism may develop thyroid storm after experiencing one of the following:

Trauma

Blunt neck trauma can injure the thyroid gland. This, in turn, could lead to a rupture of the acini and liberation of thyroid hormones into the bloodstream. This can lead to a thyroid storm. The diagnosis of the injury is based on patient history and physical examination. It is established after careful neck exploration.

Severe emotional distress

Under stress, your body will release the hormone cortisol. Cortisol is known to interfere with thyroid hormone production. The excess thyroid hormones can then cause hyperthyroidism.

Congestive heart failure

A cardiopulmonary failure is a precipitating factor for increasing the risk of thyroid storm in those with hyperthyroidism. It becomes a common cause of death in those with thyroid storm. Prompt treatment is critical for the survival of patients with such conditions.

Diabetic ketoacidosis

Diabetic ketoacidosis (DKA) is another precipitating factor for increasing the chances of thyroid storm in those with hyperthyroidism. The diagnosis is made based on clinical presentation since laboratory tests will take time. It is not advisable to wait for the laboratory test results. This is because starting treatment early could potentially save the patient’s life.

Thyroid Storm and Graves Disease

Graves disease is an immune system disorder that leads to hyperthyroidism. There could be several causes for hyperthyroidism, but Graves disease is a common cause for it. Thyroid hormones affect nearly all the organ systems of the body. Because of this, the symptoms for Graves disease could be wide-ranging. It is more commonly seen in women and before the age of 40. The primary goal is to lessen the severity of symptoms and to inhibit the overproduction of hormones.

Risk factors for a thyroid storm

The two risk factors for thyroid storm are:

Sex

Thyrotoxicosis is more than three times common in females than in males, especially in the case of prepubertal children. Only a small percentage of people with thyrotoxicosis are affected by thyroid storm. Though the incidence is presumed to be higher in females, there is no data to support this.

Age

The most number of cases of childhood thyrotoxicosis happens in children aged 10-15 years, that is, in adolescents. More than 1% of all babies who are born to a mother with Graves disease suffer from thyrotoxicosis. Thyrotoxicosis occurs more frequently among people aged 30–40.

Symptoms of a thyroid storm

The symptoms are similar to those of hyperthyroidism, but they are severe and sudden. The sudden onset of severe symptoms in people with thyroid storm makes it impossible for them to seek help. Common symptoms of thyroid storm include:

  • High fever
  • Persistent sweating
  • Racing heart rate (tachycardia), normally exceeding 140 beats per minute
  • Agitation
  • Shaking
  • Diarrhea
  • Confusion
  • Unconsciousness
  • Restlessness

Diagnosis of Thyroid Storm

Those diagnosed with hyperthyroidism earlier and showing the symptoms of a thyroid storm should be immediately admitted to an emergency room on reaching the hospital. If you suspect anyone showing the symptoms that may be of a thyroid storm, call 911 immediately. They will generally not only have an increased heartbeat rate (tachycardia) but also high blood pressure count.

The measure of the thyroid levels is a good way to determine if the patient has thyroid storm. TSH (Thyroid stimulating hormone) levels are low in cases of hyperthyroidism and thyroid storm. The American Association for Clinical Chemistry (AACC) sets the normal values for TSH from 0.5 to 5 milli–international units per liter (mIU/L). Triiodothyronine (T3) is one of the two main hormones produced by the thyroid gland. Thyroxine (T4) is the other major hormone. Both of them together help control the rate at which the body makes use of energy. T3 and T4 hormone levels are higher in those with thyroid storm.

Other complications of a hyperthyroidism

Stroke

A stroke is a brain attack that happens when blood flow to a particular area of the brain is poor and cells die as a result. Hyperthyroidism leading to stroke is a rare presentation in patients. Dysfunctional thyroid levels promote a hypercoagulable state. This excessive formation of blood clots can block blood vessels leading to an ischemic stroke.

Pulmonary Embolism

The risk for developing pulmonary embolism was more than two times greater in those with hyperthyroidism than those who did not have the condition. This was the result of a five-year follow-up study. Clinicians should be aware of this risk when treating this condition.

Osteoporosis

If hyperthyroidism is not treated in time, you also run the risk of developing osteoporosis. Uncontrolled hyperthyroidism can cause your body to pull calcium and phosphate out of your bones. These are then later excreted from the body in urine and stool as calcium and phosphorus. This can lower the mineral density in your bones, hence reducing bone strength. The resulting condition of osteoporosis makes you more prone to sustaining bone damage.

Congestive heart failure

Congestive heart failure happens when the heart does not pump blood as well as it should. Certain conditions such as narrowed arteries and hypertension can leave your heart too stiff or too weak to pump blood properly. Hemodynamic changes that take place because of hyperthyroidism can lead to congestive heart failure.

Treatment for Thyroid Storm

Thyroid storm is a sudden and severe disease. Since the thyroid gland is critical to body functioning, damage to will affect all the organ systems of the body when there is a thyroid storm.

Hyperthyroidism is a condition that requires continuous care. The doctor may administer radioactive iodine to destroy the thyroid gland. Medications like propylthiouracil (also called PTU) or methimazole (Tapazole), which reduce the function of the thyroid gland, will be administered.

Such medications are called antithyroid medications. Upon the use of radioactive iodine, the thyroid gland is subject to fibrosis and disappears over many weeks or sometimes over many months. Hypothyroidism is an immediate effect of the destruction of the thyroid and is to be expected. In some cases, the doctor may perform a procedure called thyroidectomy to remove the thyroid gland.

Symptomatic treatment of hyperthyroidism would include oral rehydration, as the body will be dehydrated. Beta-blockers may be administered to provide relief from neurologic and cardiovascular symptoms. Vision-related disorders might be treated with medications. The doctor may also use orbital decompression surgery or ocular radiation therapy.

Pregnant women who have hyperthyroidism would not be treated with radioactive iodine. Doing this will harm the unborn baby. In such cases, the woman’s thyroid would be removed surgically. Radioactive iodine is also not given to children who are younger than 5 years and to patients who have severe ophthalmopathy. In such cases, only antithyroid medication will be used, and in extreme cases, the doctor will resort to surgery to remove the thyroid.

After treatment for 12-18 months, those with Graves disease may experience remission, but recurrences are common within the following year.

If people with thyroid storm, take iodine in lieu of medical treatment, it could worsen their condition. If your thyroid is removed surgically or it is destroyed by administering radioactive iodine, then you would need to take synthetic thyroid hormones for the rest of your life.

Thyroidectomy is reserved for certain circumstances. These include the following:

  • Children with severe hyperthyroidism
  • Patients with severe ophthalmopathy or large goiters.
  • Pregnant women who are intolerant or refuse treatment with antithyroid
  • All patients who refuse therapy with radioactive iodine
  • Patients who require normalization of thyroid functions quickly, such as pregnant women, women who desire pregnancy in the next 6 months, or patients with unstable cardiac conditions

Thyroid storm is an extreme case of hyperthyroidism left untreated. The disease spirals out of control and leads to thyroid storm, a life-threatening condition. As the saying goes, better safe than sorry. It is better to treat hyperthyroidism or its most common cause of Graves disease before it leads to a thyroid storm. Antithyroid medication is a more sustainable approach whereas radioactive iodine alleviates the condition altogether by destroying the thyroid gland. In rare cases, thyroidectomy is also done. This involves surgical removal of the thyroid gland.

 

Dos and Don'ts

Dos
  • Admit those with the symptoms of a thyroid storm and a medical history of hyperthyroidism to the emergency ward.
  • Take synthetic thyroid hormones as when required following a thyroidectomy.
  •  Rehydrate the body because it will be dehydrated after a thyroid storm.
Don'ts
  • Administer radioactive iodine to pregnant women and children.

 

 

 

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Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
Green, brown, & bitter: The instant advantages of including fenugreek in your diet Did you know the earliest usage of fenugreek can be traced back to the Egyptian civilization? Find out…
Kava: Is it the healthy substitute for alcohol you have been waiting for? Native to the beautiful South Pacific islands, Kava is a famous beverage rooted in the local culture. It…
Glucose-6-Phosphate Dehydrogenase (G6PD) test Glucose-6-phosphate dehydrogenase (G6PD) is an enzyme that is found in every cell of the body and it plays…
stress depressed anxiety
Are you depressed or just stressed? Know when to see a doctor Why are some people more anxious than others? Is being depressed the same as feeling sad? Have you…
APL IgM Test
Antiphospholipid Antibody(APL)-IgM test The antiphospholipid antibodies are specific protein in the body directed against the phospholipids. It is used to detect…
alcohol toxic
7 startling facts that will make you quit alcohol today Does drinking really make you friendly and happy? How many calories does a can of cold beer add…
helping friend with depression
Support and care tips for helping people with depression Read to find out what is depression, its causes and symptoms. Also check out the steps describing how…
Blood Disorders cancer
Immunotherapy immunotherapy is a treatment that boosts the body's immune system to identify the cancer cells and fight cancer.
Lung cancer xray
Lobectomy Lobectomy is a surgery where a lobe of the diseased lung is removed. It is mainly done to…
heartfail_2
Open Heart Surgery An open heart surgery is a major procedure performed to treat heart diseases like congenital heart problem, heart…
Coffee Enema: Turn your favorite morning beverage into a powerful colon cleanser The wonders of coffee are not just limited to waking you up every morning. You can now use…
Quinine: How gin and tonic came to be known as a potent health elixir The discovery of quinine-containing tree bark is sometimes considered the most serendipitous medical discovery of the 17th century.
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
Shilajit: A miracle Himalayan herb for an active and happy life The Himalayas contain more wonders than you thought. Shilajit is a miracle herb that is widely used in…
Jack in the box fast food
Jack In the Box : The perils of surging fast food culture in the USA Jack in the Box - How a culture of fast-food can clog your arteries, weaken your heart, fatten…
anti ds dna test
Anti Ds-DNA antibody Test The  Anti Ds-DNA antibody test is used to diagnose the disease called lupus or more aptly the SLE(Systematic…
Ca 19.9 test
CA19.9 Test CA 19.9 is a cancer antigen that exists on the surface of cancer-causing cells. The levels of CA…
These are the top foods to increase your hemoglobin count It is important to add iron-rich foods into your diet in order to increase hemoglobin. Deficiency of hemoglobin could…
Vagus nerve: 7 health benefits of stimulating the “gut-brain” connection As a matter of fact, there are two vagus nerves namely the left and the right but is…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
CLA: A breakthrough weight loss supplement with minimal side effects Tried every weight loss supplement in the market with no substantial gain? Why not try CLA supplements, derived…
HSV-1_IGG
Herpes Simplex Virus I (HSV)-IgG Test Herpes simplex virus I(HSV)-IgG is an Immunoglobulin protein that acts as an antibody & stays in the blood…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
What is Qigong and how can it help you channelize you inner “Qi”? Qigong is an integrated way of performing a traditional exercise regimen that can help in promoting health, mental…
Tissue Transglutaminase Antibody (tTG) Test Transglutaminase is an enzyme present in our body and is involved in protein metabolism. A tTg test is…
6 arguments in favour of glucosamine and where can you find it Studies have shown that glucosamine works by preventing the breakdown of cartilage of the joints. This is usually…
xylitol gum
Xylitol : Is this the right sugar substitute for you? Discovered during World War 2 owing to sugar shortage, xylitol has become a common name in pharamaceutical industry.…
vital organ diseases
Common diseases that could cripple your vital organs Brain, heart, kidney, lungs, and liver - these vital organs are indeed vital for your survival. However, these…
Cordyceps: How the Caterpillar fungus works as a proven cancer-shield Strange as it may sound, but cordyceps or "caterpillar fungus", a fungus variety native to the Himalayas may…
reflexology massage
Top reasons why you should go for a reflexology massage today Reflexology involves the application of pressure to your feet and hands to encourage self-healing. Could this be beneficial…
General adaptation syndrome: Understanding stress, one step at a time The struggle of the body to produce hormones during a stressful situation is the main theme of general…
Thyroid disorders
Thyroid Profile Thyroid profile is a panel of blood tests performed to check if an individual is suffering from any…
Tamarind: The top health benefits of this staple Asian ingredient Did you know this sweet and sour pulpy fruit does more than just add a tangy flavor to…
Hibiscus: Nourish your beauty and health with these vibrant blooms Hibiscus is a trumpet shaped flower found abundantly in tropical countries. It has been historically used for its…
Erythritol: A healthy sugar substitute or yet another marketing ploy? Erythritol is a popular choice of a healthy alternative sweetening agent in foods. But how healthy can a…
Trisodium Phosphate: How a paint thinner made its way into your breakfast Ever thought how toxic chemicals find their way into our foods? How can they harm our body? And…
Miracle extract from the root of maca: 10 ways it can help you! Maca root has been used for years in herbal medicine. Today scientific research is unearthing fresh evidence in…
folate test
Folate test The Folate test measures and monitors the levels of folic acid in the blood. This test is also…
Psyllium Husk: More than just an effective natural laxative Psyllium husk, or isabgol, is a popular natural laxative . But did you in addition to regulating bowels,…
Alp enzyme-test
ALP test – Alkaline Phosphate ALP or alkaline phosphate is an enzyme mainly produced by the liver and gallbladder. ALP test measures the…
iron deficiency profile
Iron Deficiency Profile An iron deficiency profile is a battery of blood tests which are performed in order to determine the…
edamame
Edamame: How healthy are these green baby beans? Edamame or "immature" soybeans are soft and easily digestable forms of soybeans that are great as an eveyday…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
sodium chloride
Halotherapy: How inhaling salt can work wonders for your body Halotherapy is quickly gaining popularity amongst those with respiratory diseases. It has shown promise in its treatment.
Love tea, hate tannins? Rooibos tea is just what you need The market is brimming with a multitude of herbal teas. But what makes rooibos tea (or red bush)…

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