Thyroid Storm

Thyroid storm is a life-threatening thyroid disease that occurs due to excessive amounts of thyroid hormones. This is a condition of severe hyperthyroidism that occurs due to lack of or improper hyperthyroidism treatment.  It is a severe condition that needs immediate and aggressive treatment.

Also known as Thyrotoxic crisis, thyroid storm throws the body into a hypermetabolic state by the release of excessive amounts of thyroid hormones. Thyroid storm is a rare condition and is known to affect children with undiagnosed hyperthyroidism, and people who already have hyperthyroidism which is aggravated by non-thyroid conditions like trauma, surgery, infections, and increased iodine consumption in a short period of time.

People with hyperthyroidism due to toxic multinodular goiter, toxic adenoma, or Graves’ disease are all susceptible to get thyroid storm.

What happens in a thyroid storm?

In a thyroid storm, TSH levels are suppressed and there is an increase in the levels of T3 and T4. With higher concentrations of T3 and T4 in thyroid storm, the body goes into hypermetabolism and there is increased heartbeat (tachycardia), high blood pressure, and abnormalities of the nervous system and gastrointestinal system.

When it comes to a rise in the blood pressure, there is a sharp rise in the systolic blood pressure; however, the diastolic pressure plummets. Along with the above mentioned symptoms, there is also shortness of breath and a general state of confusion and anxiety. Some people even experience jaundice with the skin and eye color turning yellow.

Symptoms of thyroid storm

  • High fever
  • Chest pain
  • Trouble breathing
  • Excessive sweating
  • Abdominal pain
  • Diarrhea
  • Heat intolerance
  • Tremors
  • Skin and eye color turning yellow

These symptoms occur as all the organs of the body are affected by an increased level of thyroid hormones, especially T3. When tissues of the body are exposed to high levels of thyroid hormones, there is an increase in oxygen consumption, increase in the body’s metabolism, and an increase in the activity of the sympathetic nervous system.

With an increase in the metabolism, there is fever and increased sweating. This leads to a loss of electrolytes and accompanied dehydration. This condition is also accompanied by difficulty breathing and increased heartbeat that can escalate into cardiac failure.

Due to the increase in the levels of thyroid hormones, there is a direct impact on the liver leading to abnormal liver function. That is why the skin of people undergoing a thyroid storm turns yellow. With abnormal liver function, there is jaundice and abdominal pain, nausea, and vomiting.

Due to the involvement of multiple organs in thyroid storm, it can lead to seizures, coma, and congestive heart failure if left untreated or is not diagnosed timely.

Thyroid storm diagnosis

Since people with overactive thyroid glands are susceptible to go into a thyroid storm, upon noticing any of the above mentioned symptoms the patient should immediately rushed to a hospital with acute care services.

However, when it comes to the diagnosis of a thyroid storm, there is some amount of difficulty. This is because the thyroid function test parameters like T3, T4, and TSH level might not be  different from other people with hyperthyroidism (without thyroid storm).

People with overactive thyroid glands also having other coexisting conditions like infections, cardiac emergencies, pregnancy, and cancer treatment. These people are more susceptible to go into a thyroid storm. That is why it is important to consider the coexisting conditions in people with hyperthyroidism.

Thyroid storm treatment

The immediate goal of treating thyroid storm is to decrease the synthesis of thyroid hormones and stop the action of already released thyroid hormones on the organs of the body. This would ensure the heart rate reaching normalcy along with breathing rate, liver function, and other parameters. Treatment of the coexisting condition is also taken up in order to make recovery faster.

Medications like antithyroid medications, iodine, beta blockers, corticosteroids, and at times lithium are administered. In some rare cases, thyroidectomy surgery is also considered.