Thyroid storm: Difference between revisions
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|bgcolor="Beige"| Pseudoephedrine, Salicylates, NSAID, Chemotherapy, excessive thyroid hormone ingestion, Withdrawal or non compliance with antithyroid medication. | |bgcolor="Beige"| Pseudoephedrine, Salicylates, NSAID, Chemotherapy, excessive thyroid hormone ingestion, Withdrawal or non compliance with antithyroid medication, acute iodine load. | ||
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|bgcolor="Beige"| Transplacental passage of maternal thyroid hormone immunoglobulins in neonates, toxemia of pregnancy, molar pregnancy. | |bgcolor="Beige"| Transplacental passage of maternal thyroid hormone immunoglobulins in neonates, toxemia of pregnancy, molar pregnancy, parturition. | ||
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Revision as of 15:03, 20 August 2012
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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, enhanced response to thyroid hormones at the cellular level, presence of unique catecholamine like substance in hyperthyroidism or due to direct sympathomimetic effect of thyroid hormone due to its structural similarity to catecholamines . The exact cause is not clear. 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
Causes by Organ System
| Cardiovascular | No underlying causes |
| Chemical / poisoning | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Pseudoephedrine, Salicylates, NSAID, Chemotherapy, excessive thyroid hormone ingestion, Withdrawal or non compliance with antithyroid medication, acute iodine load. |
| Ear Nose Throat | No underlying causes |
| Endocrine | TSH secreting tumour, Hyperfunctioning thyroid nodule, Hyperfunctioning multinodular goiter, diabetic ketoacidosis. |
| Environmental | No underlying causes |
| Gastroenterologic | No underlying causes |
| Genetic | McCune Albright syndrome |
| Hematologic | No underlying causes |
| Iatrogenic | No underlying causes |
| Infectious Disease | Recent infection. |
| Musculoskeletal / Ortho | No underlying causes |
| Neurologic | No underlying causes |
| Nutritional / Metabolic | No underlying causes |
| Obstetric/Gynecologic | Transplacental passage of maternal thyroid hormone immunoglobulins in neonates, toxemia of pregnancy, molar pregnancy, parturition. |
| 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 | Direct trauma to the gland. |
| Urologic | No underlying causes |
| Dental | No underlying causes |
| Miscellaneous | Anaesthesia induction, vigorous palpation of thyroid gland, any surgery. |
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
Children aged 10-15 years account for greater than 2/3rd cases of thyrotoxicosis. Hence, thyroid storm is more common in adolescents though it can occur in any age group.
Gender
Hyperthyroidism is 3-5 times more common in females than males. Incidence of thyroid storm is presumed to be higher in females but no clear data is available.
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.