Medicine

Last updated on: July 9th, 2021

Thyroid storm

Clinicals - History

Introduction

Thyroid storm, also known as a thyrotoxic crisis, is a medical emergency that occurs in persons with hyperthyroidism. It can lead to acute multisystem failure and death.

Precipitating factors

In patients who are hyperthyroid, any condition that results in significant physiological stress can precipitate a thyroid storm; examples include infections, diabetic emergencies, pulmonary embolism, surgery, trauma, and childbirth. In addition, the untimely withdrawal of antithyroid medications can lead to rebound thyrotoxicosis; and the use of radioactive iodine can lead to a massive release of thyroid hormones from the thyroid follicles, precipitating thyroid storm.

Constitutional symptoms

Constitutional symptoms such as weakness and fatigue may occur. These are due to adrenergic hyperactivity and exaggerated excitability of the muscles and central nervous system (CNS).

Neuropsychiatric symptoms

A wide range of neuropsychiatric symptoms may occur. These include anxiety, hyperirritability, emotional lability, confusion, apathy, and coma. Rarely, dramatic psychotic symptoms, such as delusional parasitosis, can occur. The pathophysiology is complex; however, thyroid hormones are known to influence neurotransmitter release and hormone activation.

Palpitations

Palpitations are common. This is because thyroid hormones directly increase cardiac contractility; and when in excess, cause adrenergic hyperactivity.

Gastrointestinal symptoms

Gastrointestinal (GI) symptoms include jaundice, abdominal pain, and diarrhea. Jaundice is due to liver dysfunction; this may be due to acompanying autoimmune disease, or heart failure causing hepatic congestion and reduced blood flow. In patients who are purely hyperthyroid (i.e., without other complications), the pathophysiology of the liver dysfunction is unclear. Diarrrhea is due to increased motility, malabsorption, and increased adrenergic activity.

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