Thyroid storm
Background
Inciting causes:
1) graves
2) goiter
3) thyroiditis
4) iatrogenic
wolff-chaikoff effect: increased iodine concentration leads to transient decrease of T3/T4
Diagnosis
Classic Triad: hyperthermia, tachycardia, AMS
Burch & Wartofsky Criteria
I. Thermoregulatory dysfunction (Temperature)
99-99.9 5 100-100.9 10 101-101.9 15 102-102.9 20 103-103.9 25 104.0 30
II. Central nervous system effects
Mild (Agitation) 10 Moderate (delirium, psychosis, extreme lethargy) 20 Severe (seizure, coma) 30
III. Gastrointestinal-hepatic dysfunctionModerate (diarrhea, n/v, abd pain) 10
Severe (unexplained jaundice) 20
IV. Cardiovascular dysfunction (tachycardia)99-109 5
110-119 10
120-129 15
130-139 20
140 25
V. Congestive heart failureMild (pedal edema) 5
Moderate (bibasilar rales) 10
Severe (pulm edema, A. fib) 15
VI. Precipitant historyNegative 0
Positive 10
Scoring
>45 = highly suggestive
25-44 = supports diagnosis
<25 = unlikely
Treatment
- High dose PTU
- Beta blockers
- Corticosteroids
- + Inorganic iodine (1 hour after PTU)
==Disposition==
Admit
See Also
Endo: Thyroid Data
Endo: Hyperthyroidism
Sources
Burch, HB, Wartofsky, L, Endocrinol Metab Clin North Am 1993; 22:263.