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Revision as of 14:28, 20 August 2012

For patient information, click Thyroid storm

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Thyrotoxic storm, accelerated hyperthyroidism, hyperthyroid storm

Overview

An unusual but life threatening condition develops in patients with hyperthyroidism either due to poorly controlled pre existing hyperthyroidism or due to medical conditions that precipitate a crisis situation called thyroid storm. There develops a hypermetabolic state that leads to its development. It is mainly a clinical diagnosis and warrants prompt treatment.

Historical Perspective

Classification

Pathophysiology

Thyroid storm is a state of decompensation of the hyperthyroid gland. It could be either due to increased levels of thyroid hormones, increased responsiveness to catecholamines or enhanced response to thyroid hormones at the cellular level. Also, it has been found that it is only the free T4 and T3 that are high. The levels of total T4 and T3 are fairly similar to those found in hyperthyroidism. For a hyperthyroid patient just being intolerant to heat and exhibiting diaphoresis, thyroid storm makes one hyperpyrexic. The enhanced metabolism is translated into increased oxygen and energy consumption. Similarly, moderate tachycardia of hyperthyroidism enhances to hypertension , arrhythmias and possibly high output heart failure. Irritable and restless patient of hyperthyroidism now has agitation, delirium, seizures and could progress to coma. The exact cause behind this heightened effect is unclear.

Genetics

Associated Conditions

Gross Pathology

Microscopic Pathology

Causes

Common Causes

Recent infection

Discontinuation of medication

Medical stressors like myocardial infarction

Acute iodine load

Parturition

Causes by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Dental	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

A...
Z...

Make sure that each diagnosis is linked to a page.

Differentiating type page name here from other Diseases

Epidemiology and Demographics

The frequency of thyroid storm is unknown in children. In a national survey in Japan, incidence of thyroid storm in hospitalized patient was found to be 0.20 per 100,000 per year. If the diagnosis is promptly made and early management initiated, the adult mortality rate is less than 20% contrary to a rate of 90% if patient left untreated.

Age

Gender

Race

Developed Countries

Developing Countries

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History

A directed history should be obtained to ascertain

Symptoms

"Type symptom here" is pathognomonic of the "type disease name here".

"Type non specific symptoms" may be present.

Past Medical History

Family History

Social History

Occupational

Alcohol

The frequency and amount of alcohol consumption should be characterized.

Drug Use

Smoking

Allergies

Physical Examination

Appearance of the Patient

Vital Signs

Skin

Head

Eyes

Ear

Nose

Throat

Heart

Lungs

Abdomen

Extremities

Neurologic

Genitals

Other

Laboratory Findings

Electrolyte and Biomarker Studies

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Pharmacotherapy

Acute Pharmacotherapies

Chronic Pharmacotherapies

Surgery and Device Based Therapy

Indications for Surgery

Pre-Operative Assessment

Post-Operative Management

Transplantation

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

References

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
+__NOTOC__
+{{SI}}
+'''For patient information, click [[Thyroid storm (patient information)|Thyroid storm ]]'''
+{{CMG}}
+'''''Synonyms and keywords:''''' Thyrotoxic storm, accelerated hyperthyroidism, hyperthyroid storm
+== Overview ==
+An unusual but life threatening condition develops in patients with hyperthyroidism either due to poorly controlled pre existing hyperthyroidism or due to medical conditions that precipitate a crisis situation called thyroid storm. There develops a hypermetabolic state that leads to its development. It is mainly a clinical diagnosis and warrants prompt treatment.
+==Historical Perspective==
+==Classification==
+== Pathophysiology==
+Thyroid storm is a state of decompensation of the hyperthyroid gland.  It could be either due to increased levels of thyroid hormones, increased responsiveness to catecholamines or enhanced response to thyroid hormones at the cellular level. Also, it has been found that it is only the free T4 and T3 that are high. The levels of total T4 and T3 are fairly similar to those found in hyperthyroidism. For a hyperthyroid patient just being intolerant to heat and exhibiting diaphoresis, thyroid storm makes one hyperpyrexic. The enhanced metabolism is translated into increased oxygen and energy consumption. Similarly, moderate tachycardia of hyperthyroidism enhances to hypertension , arrhythmias and possibly high output heart failure. Irritable and restless patient of hyperthyroidism now has agitation, delirium, seizures and could progress to coma. The exact cause behind this heightened effect is unclear.
+=== Genetics ===
+=== Associated Conditions===
+===Gross Pathology===
+===Microscopic Pathology===
+==Causes==
+===Common Causes===
+*[[Any surgery]]
+*[[Trauma]]
+*[[Recent infection]]
+*[[Discontinuation of medication]]
+*[[Medical stressors like myocardial infarction]]
+*[[Acute iodine load]]
+*[[Parturition]]
+===Causes by Organ System===
+{|style="width:80%; height:100px" border="1"
+|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Chemical / poisoning'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Dermatologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Drug Side Effect'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Ear Nose Throat'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Endocrine'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Environmental'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Gastroenterologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Genetic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Hematologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Iatrogenic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Infectious Disease'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Musculoskeletal / Ortho'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Neurologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Nutritional / Metabolic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Obstetric/Gynecologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Oncologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Opthalmologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Overdose / Toxicity'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Psychiatric'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Pulmonary'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Renal / Electrolyte'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Rheum / Immune / Allergy'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Sexual'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Trauma'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Urologic'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Dental'''
+|bgcolor="Beige"| No underlying causes
+|-
+|-bgcolor="LightSteelBlue"
+| '''Miscellaneous'''
+|bgcolor="Beige"| No underlying causes
+|-
+|}
+===Causes in Alphabetical Order===
+*A...
+*Z...
+Make sure that each diagnosis is linked to a page.
+==Differentiating type page name here from other Diseases==
+== Epidemiology and Demographics ==
+The frequency of thyroid storm is unknown in children. In a national survey in Japan, incidence of thyroid storm in hospitalized patient was found to be 0.20 per 100,000 per year. If the diagnosis is promptly made and early management initiated, the adult mortality rate is less than 20% contrary to a rate of 90% if patient left untreated.
+===Age===
+===Gender===
+===Race===
+===Developed Countries===
+===Developing Countries===
+== Risk Factors ==
+== Screening ==
+== Natural History, Complications and Prognosis==
+== Diagnosis ==
+===History===
+A directed history should be obtained to ascertain
+=== Symptoms ===
+"Type symptom here" is pathognomonic of the "type disease name here".
+"Type non specific symptoms" may be present.
+===Past Medical History===
+===Family History===
+===Social History===
+====Occupational====
+====Alcohol====
+The frequency and amount of alcohol consumption should be characterized.
+====Drug Use====
+====Smoking====
+===Allergies===
+=== Physical Examination ===
+==== Appearance of the Patient ====
+====Vital Signs====
+====Skin====
+====Head====
+==== Eyes ====
+==== Ear ====
+====Nose====
+====Throat ====
+==== Heart ====
+==== Lungs ====
+==== Abdomen ====
+==== Extremities ====
+==== Neurologic ====
+====Genitals====
+==== Other ====
+=== Laboratory Findings ===
+==== Electrolyte and Biomarker Studies ====
+==== Electrocardiogram ====
+==== Chest X Ray ====
+====CT ====
+==== MRI ====
+==== Echocardiography or Ultrasound ====
+==== Other Imaging Findings ====
+=== Other Diagnostic Studies ===
+== Treatment ==
+=== Pharmacotherapy ===
+==== Acute Pharmacotherapies ====
+==== Chronic Pharmacotherapies ====
+=== Surgery and Device Based Therapy ===
+==== Indications for Surgery ====
+==== Pre-Operative Assessment ====
+==== Post-Operative Management ====
+==== Transplantation ====
+=== Primary Prevention ===
+=== Secondary Prevention ===
+=== Cost-Effectiveness of Therapy ===
+=== Future or Investigational Therapies ===
+==References==
+{{reflist|2}}
+{{WikiDoc Help Menu}}
+{{WikiDoc Sources}}
+[[Category:Disease]]