Clinical Features and Hospital Outcomes in Thyroid Storm: A Retrospective Cohort Study

Angell, Trevor E.; Lechner, Melissa G.; Nguyen, Caroline T.; Salvato, Victoria L.; Nicoloff, John T.; LoPresti, Jonathan S.

doi:10.1210/jc.2014-2850

Cited by 110 publications

(113 citation statements)

References 23 publications

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“…Anxiety, agitation, delirium and coma are also commonly seen and are considered by many as essential to the diagnosis (4). In one study, altered mental status was the only reliable differentiating feature between thyroid storm and thyrotoxicosis (11). Cardiac manifestations include cardiac arrhythmias, congestive heart failure, hypotension and death may also occur from cardiovascular collapse (12).…”

Section: Discussionmentioning

confidence: 99%

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Dhillon¹,

Manocha²,

Kahlon³

et al. 2017

Am J Hosp Med

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Altered mental status (AMS) is a challenging symptom, commonly encountered in the acute hospital setting. We present a challenging case of AMS where an early assessment could have potentially prevented a complicated hospital course. A 42-year-old male presented to emergency room with chest pain. He was tachycardic, hypotensive and electrocardiogram showed new ST depressions. He underwent emergent cardiac catheterization showing triple vessel disease with placement of intra-aortic balloon pump, followed by CABG. Post-operatively he could not be extubated and had persistent fever, tachycardia and deterioration in mental status. Initial work up for fever and AMS was unremarkable. He was treated with broad spectrum antibiotics and beta blockers but remained intubated, febrile, and altered. Thyroid function tests done around second week of hospitalization revealed TSH < 0.03uU/ml, fT4 > 4.5 ng/dl, T3 411.9 ng/dl, thyroid stimulating immunoglobulin 269%. A thyroid sonogram revealed diffusely enlarged, heterogeneous and hypervascular thyroid lobes. He was started on stress doses of steroids, propylthiouracil and continued on beta blocker. Within the next 72 hours his heart rate, fever and mental status improved and he was extubated. Thyroid storm, also referred to as thyrotoxic crisis, is an acute life threatening hypermetabolic state induced by excessive release of thyroid hormones in a patient with thyrotoxicosis. It is often precipitated by an acute event such as surgery, trauma, infection or iodine load. The Burch and Wartofsky scoring system is helpful in distinguishing this from severe thyrotoxicosis. It should always be kept in the differential diagnosis of AMS, fever, tachycardia of unknown cause.

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Section: Discussionmentioning

confidence: 99%

Post Coronary Artery Bypass Graft (CABG) Surgery Thyroid Storm: A Near Miss

Dhillon¹,

Manocha²,

Kahlon³

et al. 2017

Am J Hosp Med

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“…Treatment generally requires ICU monitoring and aims to restore thyroid gland function and at the same time diminish thyroid hormone effects on peripheral tissues with a combination of β blockers, thyrostatics, intravenous glucocorticoids, and eventually a high-dose of iodide compounds. 86 In a retrospective cohort study 87 of patients admitted to hospital with acute thyrotoxicosis, the presence of CNS dysfunction was the only significantly different clinical feature between patients with thyroid storm and those with compensated thyrotoxicosis. Thus, patients with thyrotoxicosis, possible thyroid storm, and altered mentation should be treated aggressively with supportive measures and antithyroid drugs.…”

Section: Diagnosis and Management Of Severe Primary Thyroid Disordersmentioning

confidence: 99%

Thyroid function in critically ill patients

Fliers

Bianco

Langouche

et al. 2015

The Lancet Diabetes & Endocrinology

334

318

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Patients in the intensive care unit (ICU) typically present with decreased concentrations of plasma tri-iodothyronine, low thyroxine, and normal range or slightly decreased concentration of thyroid-stimulating hormone. This ensemble of changes is collectively known as non-thyroidal illness syndrome (NTIS). The extent of NTIS is associated with prognosis, but no proof exists for causality of this association. Initially, NTIS is a consequence of the acute phase response to systemic illness and macronutrient restriction, which might be beneficial. Pathogenesis of NTIS in long-term critical illness is more complex and includes suppression of hypothalamic thyrotropin-releasing hormone, accounting for persistently reduced secretion of thyroid-stimulating hormone despite low plasma thyroid hormone. In some cases distinguishing between NTIS and severe hypothyroidism, which is a rare primary cause for admission to the ICU, can be difficult. Infusion of hypothalamic-releasing factors can reactivate the thyroid axis in patients with NTIS, inducing an anabolic response. Whether this approach has a clinical benefit in terms of outcome is unknown. In this Series paper, we discuss diagnostic aspects, pathogenesis, and implications of NTIS as well as its distinction from severe, primary thyroid disorders in patients in the ICU.

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“…The usefulness of the BWPS and JTA criteria has been compared by analyses of JTA nationwide surveys [4], and recently by 2 institutions that showed overall agreement between the 2 systems [21,22]. However, a report from the United States suggested that the BWPS ≥ 45 appeared to select a higher percentage of patients for aggressive therapy than the JTA criteria [21].…”

Section: Basic Policymentioning

confidence: 99%

“…However, a report from the United States suggested that the BWPS ≥ 45 appeared to select a higher percentage of patients for aggressive therapy than the JTA criteria [21]. Using both diagnostic systems to evaluate a patient's condition is recommended to increase the accuracy of clinical diagnosis and further validate the usefulness of these 2 sets of criteria.…”

Section: Basic Policymentioning

confidence: 99%