National Trends in Incidence, Mortality, and Clinical Outcomes of Patients Hospitalized for Thyrotoxicosis With and Without Thyroid Storm in the United States, 2004–2013

Abstract

Background: Current evidence on the incidence and outcomes of patients with thyroid storm in the United States is limited to single-center case series. This study determined the national incidence of thyrotoxicosis with and without thyroid storm and clinical outcomes among hospitalized patients during a 10-year period in the United States. Methods: Retrospective longitudinal analysis was conducted of clinical characteristics, mortality, hospital length of stay, and costs from 2004 to 2013. Adults (‡18 years of age) with a primary diagnosis of thyrotoxicosis with and without thyroid storm were included. To determine the incidence, outcomes, and cost of thyrotoxicosis with and without thyroid storm, the study used data from the National Inpatient Sample database, the largest public inpatient database, with a representative sample of all non-federal hospitals in the United States. Results: Among 121,384 discharges with thyrotoxicosis during the study period (M agestandard error = 48.7-0.11 years; 51.9% Caucasian; 77.3% female), 19,723 (16.2%) were diagnosed with thyroid storm. During the past decade, the incidence of thyroid storm ranged between 0.57 and 0.76 cases/100,000 U.S. persons per year, and 4.8 and 5.6/ 100,000 hospitalized patients per year. Thyroid storm was associated with significantly higher hospital mortality (1.2-3.6% vs. 0.1-0.4%, p < 0.01) and longer length of stay (4.8-5.6 vs. 2.7-3.4 mean days, p < 0.001) compared to patients with thyrotoxicosis without storm. Inflation-adjusted hospitalization costs progressively increased in patients with thyroid storm from $9942 to $12,660 between 2004 and 2013 (p < 0.01). Conclusions: One of every six discharges for thyrotoxicosis was diagnosed with thyroid storm. Thyroid storm is associated with a 12-fold higher mortality rate compared to thyrotoxicosis without storm. The incidence and mortality of thyroid storm has not substantially changed in the past decade. However, hospitalization costs have significantly increased.

Thyrotoxic Crisis and COVID-19 Infection: An Extraordinary Case and Literature Review

“…In national researches from the United States and Japan, the incidence of thyroid storm was 0.57 to 0.76 and 0.20 per 100,000 persons per year, respectively [7][8]. Although thyroid storms may arise in patients with longstanding untreated hyperthyroidism, they are often precipitated by an acute underlying event.…”

Thyroid storm after coronary artery bypass surgery: a case report

“…Thyroid storm can be triggered by an acute event or trauma, such as surgery involving the thyroid or other areas, infection, and parturition [1][2][3]. Among the various precipitating factors, a recent study showed that irregular use or discontinuation of antithyroid drugs is the most common factor [3].…”

“…The incidence of thyroid storm was 0.20-0.76/100, 000 persons per year, with 4.8-5.6/100,000 hospitalized patients per year [2,3]. In a United States survey, 16% of inpatients with thyrotoxicosis were diagnosed with thyroid storm, which was associated with a significantly higher mortality rate than that in patients with thyrotoxicosis without thyroid storm [2]. Thyroid storm may be precipitated due to the irregular use or discontinuation of antithyroid medication and an acute event such as thyroid or nonthyroidal surgery or infection, especially of the upper respiratory tract [2,3].…”

“…Thyroid storm is a rare, life-threatening disease characterized by severe clinical manifestations of thyrotoxicosis [1]. The incidence of thyroid storm was 0.20-0.76/100, 000 persons per year, with 4.8-5.6/100,000 hospitalized patients per year [2,3]. In a United States survey, 16% of inpatients with thyrotoxicosis were diagnosed with thyroid storm, which was associated with a significantly higher mortality rate than that in patients with thyrotoxicosis without thyroid storm [2].…”

“…In a United States survey, 16% of inpatients with thyrotoxicosis were diagnosed with thyroid storm, which was associated with a significantly higher mortality rate than that in patients with thyrotoxicosis without thyroid storm [2]. Thyroid storm may be precipitated due to the irregular use or discontinuation of antithyroid medication and an acute event such as thyroid or nonthyroidal surgery or infection, especially of the upper respiratory tract [2,3]. One of the cardiovascular events caused by thyroid storm following coronary artery bypass graft (CABG) is high output heart failure with extreme tachycardia, which can be fatal.…”