Thyroid storm is a hypermetabolic medical emergency that may be precipitated by an acute illness or injury.


The patient usually has a history of Graves disease, thyrotoxicosis or toxic multinodular goiter.


The crisis may be precipitated by:

(1) surgery

(2) infection

(3) trauma

(4) diabetic ketoacidosis

(5) toxemia of pregnancy

(6) delivery of an infant

(7) acute thyroiditis


Clinical features:

(1) abrupt onset

(2) fever > 40°C

(3) flushing

(4) profuse sweating

(5) tachycardia

(6) tachypnea

(7) nausea and vomiting

(8) abdominal pain

(9) diarrhea

(10) dehydration

(11) tremors

(12) restlessness

(13) delirium or psychosis

(14) decreased levels of consciousness

(15) worsening of hypermetabolic state with aspirin or other drugs that displace T3 or T4 from thyroglobulin


Laboratory findings may include:

(1) hypoglycemia

(2) hypernatremia


Patients who are not treated promptly are at risk for multi-organ failure:

(1) congestive heart failure

(2) pulmonary edema with respiratory failure

(3) coma

(4) hypotension


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