What Is A Thyroid Storm?

In this article: 

• What is a thyroid storm?

• Signs and symptoms of a thyroid storm

• Care and treatment 

A thyroid storm is an uncommon, albeit severe, condition that develops from thyrotoxicosis. Hyperthyroidism is when there is an excess of thyroid hormone circulating in the bloodstream due to an overactive thyroid gland. Although it is rare for a person with hyperthyroidism to have a thyroid storm in today’s medical landscape, the mortality rate is high. 

What is a thyroid storm?

People with untreated hyperthyroidism are at risk of having a thyroid storm. Most commonly, a thyroid storm occurs in people with Graves’ disease, which is the autoimmune condition that causes the thyroid to overproduce thyroid hormone. High levels of circulating thyroid hormones, specifically T3 and T4, increase the rate of metabolism in every cell in your body. Consequently, your cells require more oxygen and more energy to meet the demands of a thyrotoxic state. 

The pathophysiology behind what causes a thyroid storm is not fully understood. However, a thyroid storm is usually caused by some significant event that stresses a body that is already in a thyrotoxic state. Thyrotoxicosis is where there is an excess of thyroid hormone in the bloodstream that can be caused by anything (such as an overdose of synthetic thyroid hormone medication). A thyroid storm is on the extreme end of a thyrotoxic spectrum. 

Historically, people who had part or all of their thyroid removed (thyroidectomy) commonly experienced a thyroid storm. However, advancements in medical technology and our understanding of the thyroid have decreased the incidence of this complication. People who have thyrotoxicosis are at increased risk for a thyroid storm if they have recently experienced:

• Infection (the most common cause of a thyroid storm)

• Trauma

• Surgery

• Diabetic ketoacidosis

• Heart attack

• Pregnancy and childbirth

• Pulmonary embolism

• Congestive heart failure

• A severe emotionally distressing event 

• Thyroid hormones overdose

Importantly, not all people who have hyperthyroidism experience a thyroid storm. Studies indicate that even people who abruptly stop using their antithyroid drugs, overdose on synthetic thyroid hormone, or have worsening thyrotoxicosis are unlikely to develop this condition. 

Signs and symptoms of a thyroid storm

‍

The symptoms of a thyroid storm are nearly the same as symptoms of hyperthyroidism. However, the symptoms come on suddenly and are extreme. Consequently, the body cannot sustain functioning, and symptoms can lead to death very quickly. Symptoms of a thyroid storm include:

• Fever of 102F or higher seen in most people

• Profuse sweating resulting in electrolyte imbalance and dehydration

• High heart rate (140 beats per minute or higher)

• Atrial fibrillation

• Heart failure

• Swelling of the limbs

• High respiratory rate

• Shaking

• Confusion, delirium, agitation, and restlessness

• Jaundice

• Diarrhea, nausea, vomiting, and abdominal pain

• Unconsciousness

Because the symptoms develop abruptly and can quickly lead to unconsciousness, people must seek emergency medical care immediately. 

Care and treatment

A thyroid storm is a life-threatening condition that must be treated acutely. Because of the rapid decline that is associated with a thyroid storm, treatment for a thyroid storm typically begins before thyroid hormone lab tests can confirm that a person is in a thyrotoxic state. Along with blood tests to assess thyroid hormone levels and to rule out other conditions, the emergency medical care team will likely perform: 

• A chest x-ray to assess for infection and fluid in the lungs

• A thyroid ultrasound

• A CT scan of the brain to rule out other causes of altered neurological functioning

• Electrocardiograph (ECG) of the heart to determine heart rhythm and rate

To prevent multi-organ failure, emergent medical care will likely use the following treatment strategies to reverse the heightened metabolic state caused by a thyroid storm:

• Reduce fever by cooling the body and giving acetaminophen (Tylenol)

• Correct dehydration with IV fluids

• Encourage optimal nutrition to prevent problems with blood glucose

• Give antithyroid medication to avert thyroid hormone from being made, which is either methimazole or propylthiouracil (PTU) 

• Give medicine to prevent thyroid hormone from being released 

• Medication to correct cardiac symptoms including rapid heart rate, irregular heart rhythms, and high blood pressure

• Steroid medication to further suppress thyroid hormone activity

If you have hyperthyroidism, it is essential to be aware of the life-threatening nature of a thyroid storm and to take action to prevent this severe condition. The best way to prevent a thyroid storm is to treat the underlying cause of hyperthyroidism. Meet with an endocrinologist to determine the best treatment plan for you and to ensure your body functions optimally. 

A note from Paloma Health

If you or a loved one suspects you may be suffering from a thyroid storm, contact 9-1-1 immediately. We at Paloma want you to be aware of the life-threatening nature of a thyroid storm and encourage you to take steps to prevent your risk for developing this condition.