{ "schemaVersion": 2, "eyebrow": "Endocrine emergency", "title": "Thyroid Storm", "summary": "Thyroid storm is a clinical diagnosis of decompensated thyrotoxicosis with acute organ dysfunction. Immediate ICU-level multimodal therapy, treatment of the precipitant, and cautious cardiovascular management are required; thyroid hormone concentrations do not distinguish storm from uncomplicated thyrotoxicosis.[8]", "seoDescription": "Thyroid storm diagnosis and ICU management: clinical scoring, urgent antithyroid therapy, iodine timing, beta-blocker selection, and rescue options.", "clinicalQuestion": "How should physicians recognize and immediately manage thyroid storm while minimizing cardiovascular and treatment-related risk?", "specialty": "Endocrinology and critical care", "audience": "U.S. physicians and medical trainees", "tags": [ "thyroid storm", "thyrotoxic crisis", "Burch-Wartofsky score", "thyrotoxicosis", "methimazole", "propylthiouracil", "thyrotoxic cardiomyopathy" ], "keyTakeaways": [ "Diagnose thyroid storm clinically from severe thyrotoxicosis plus cardiovascular, CNS, gastrointestinal/hepatic, or thermoregulatory decompensation; FT4 and FT3 concentrations do not reliably separate storm from uncomplicated thyrotoxicosis.[8]", "Do not delay ICU transfer or multimodal treatment for confirmatory laboratory results when the clinical syndrome is convincing.[8]", "Use a thionamide before iodine; administer iodine at least 1 hour later to avoid providing substrate for hormone synthesis, particularly with autonomous nodular disease.[8]", "PTU has theoretical T4-to-T3 conversion benefit, but a multicenter cohort of 1,383 adults found no mortality or adverse-event difference versus methimazole.[1][8]", "Assess for low-output heart failure or cardiogenic shock before beta-blockade. Esmolol permits rapid discontinuation; beta-blockade can precipitate cardiovascular collapse in vulnerable patients.[8][22]" ], "sections": [ { "id": "recognition-and-triage", "eyebrow": "Emergency assessment", "heading": "Recognize thyroid storm as clinical decompensation", "intro": "Treat suspected storm as an ICU emergency while diagnostic testing proceeds.", "paragraphs": [ "Thyroid storm is a life-threatening hypermetabolic state arising from severe thyrotoxicosis and characterized by acute dysfunction of one or more organ systems. Common high-risk findings are hyperthermia, tachyarrhythmia, heart failure or pulmonary edema, CNS disturbance, and gastrointestinal or hepatic dysfunction. Graves disease is the most frequent underlying cause, but toxic nodular disease, amiodarone-induced thyrotoxicosis, thyroiditis, exogenous hormone exposure, and rare hCG-mediated or malignant etiologies can precipitate crisis.[8]", "Obtain TSH, free T4, and T3, but do not use hormone magnitude to determine severity or defer treatment. Severe illness may reduce T4-to-T3 conversion, producing a relatively modest or even reference-range T3 despite thyroid storm. Assess end-organ injury and precipitants with ECG, chest imaging when cardiopulmonary involvement is suspected, CBC, metabolic panel, hepatic tests, glucose, lactate, and directed infectious or ischemic evaluation.[8]", "Admit to an ICU for continuous cardiac and respiratory monitoring. Mortality estimates vary by case definition and population; reported overall mortality is approximately 5% to 12%, rising to 30% in older adults and those with comorbidity. Cardiogenic shock, multiorgan failure, respiratory failure, arrhythmias, and sepsis are major proximate causes of death.[8]" ], "bullets": [ "Immediately establish airway, oxygenation, circulation, temperature control, IV access, and cardiac monitoring; obtain endocrinology and critical care involvement.[8]", "Actively identify and treat infection, antithyroid-drug discontinuation, surgery or trauma, iodine exposure, acute illness, and other triggers.[8]", "Avoid aspirin for fever because salicylates displace thyroid hormones from binding proteins and may increase free hormone levels; use acetaminophen plus external cooling.[8]" ], "subsections": [ { "heading": "Clinical scoring supports but does not replace judgment", "paragraphs": [ "The Burch-Wartofsky Point Scale incorporates temperature, CNS effects, gastrointestinal/hepatic symptoms, heart rate, heart failure, atrial fibrillation, and a precipitant. A score below 25 makes storm unlikely, 25 to 44 suggests impending storm, and greater than 45 is highly suggestive. Japanese Thyroid Association/Japan Endocrine Society criteria require thyrotoxicosis plus specified combinations of CNS, fever, tachycardia, heart failure, and gastrointestinal/hepatic manifestations. Neither framework should delay treatment of a clinically unstable patient.[8]" ], "bullets": [] } ], "table": { "caption": "Clinical features that should trigger immediate thyroid-storm treatment and ICU-level care.[8]", "columns": [ "Domain", "Action-relevant findings" ], "rows": [ [ "Cardiovascular", "Marked tachycardia, atrial fibrillation, pulmonary edema, congestive heart failure, hypotension, or cardiogenic shock.[8]" ], [ "CNS", "Agitation, delirium, psychosis, profound lethargy, seizure, or coma.[8]" ], [ "Thermoregulatory", "High fever, often greater than 38.5°C; use cooling and acetaminophen rather than aspirin.[8]" ], [ "Gastrointestinal/hepatic", "Vomiting, diarrhea, abdominal symptoms, jaundice, or hepatic dysfunction.[8]" ], [ "Context", "Known or suspected thyrotoxicosis with infection, medication nonadherence, surgery, trauma, major stress, or iodine exposure.[8]" ] ] } }, { "id": "immediate-treatment", "eyebrow": "ICU treatment", "heading": "Use concurrent pathway-directed therapy", "intro": "Treat systemic consequences, hormone production and release, peripheral conversion, and the precipitating disorder simultaneously.", "paragraphs": [ "Initial supportive care includes oxygen and ventilatory support as needed, cautious fluid and electrolyte replacement, cooling, acetaminophen, glucose surveillance, and treatment of the precipitating condition. Correct clinically important electrolyte and acid-base disorders and monitor for hypoglycemia, particularly in critically ill patients.[8]", "For hyperthyroidism caused by increased hormone synthesis, give a thionamide promptly, followed by iodine after at least 1 hour, glucocorticoid therapy, and appropriately selected rate control. Iodine is not a substitute for thionamide therapy in patients with autonomous nodular disease because it can increase substrate for new hormone synthesis.[8]", "Therapy should be tailored to etiology. Thionamides do not block release of preformed hormone in destructive thyroiditis or exogenous thyroid hormone ingestion; management in these settings emphasizes supportive care, beta-blockade when appropriate, glucocorticoids in selected settings, and treatment of the specific cause.[8]" ], "bullets": [], "subsections": [ { "heading": "Block synthesis with PTU or methimazole", "paragraphs": [ "PTU is traditionally favored because it also inhibits peripheral T4-to-T3 conversion. A typical regimen is PTU 500 to 1,000 mg orally, by nasogastric tube, or rectally as a loading dose, then 250 mg every 4 hours. Methimazole is an appropriate alternative at 60 to 80 mg/day. In a multicenter observational comparative-effectiveness cohort of 1,383 adults with thyroid storm, PTU and methimazole had no significant differences in mortality or adverse events.[1][8]", "Favor methimazole or carbimazole rather than PTU when bilirubin and liver enzymes are at least three times the upper limit of normal, given PTU hepatotoxicity concerns. Intravenous methimazole is not commercially available in the United States; enteral or rectal thionamide administration may be necessary when oral swallowing is not possible.[8]" ], "bullets": [ "Monitor peripheral thyroid hormone concentrations to taper thionamide dosing after clinical stabilization.[8]", "If agranulocytosis or severe thionamide toxicity precludes use, do not simply switch to the alternate thionamide; seek urgent endocrine and surgical input and consider rescue strategies.[8][20]" ] }, { "heading": "Block hormone release after thionamide therapy", "paragraphs": [ "At least 1 hour after the thionamide, administer iodine to inhibit hormone synthesis and release. Supported regimens include Lugol iodine 8 drops four times daily, saturated solution of potassium iodide 5 drops four times daily, or potassium iodide 65 mg three times daily. Discontinue iodine once the patient stabilizes, and dilute oral or nasogastric iodine preparations in milk or juice to reduce local irritation.[8]" ], "bullets": [ "Do not administer iodine before thionamide when toxic multinodular goiter or autonomous nodular disease is possible.[8]" ] }, { "heading": "Reduce peripheral conversion and address adrenal reserve", "paragraphs": [ "Administer hydrocortisone 300 mg IV as a loading dose followed by 100 mg IV every 8 hours, then taper after clinical improvement. Glucocorticoids reduce peripheral T4-to-T3 conversion and address possible relative or overt adrenal insufficiency in the hypermetabolic state.[8]" ], "bullets": [] }, { "heading": "Use beta-blockade selectively and reassess hemodynamics", "paragraphs": [ "Propranolol controls adrenergic manifestations and may reduce T4-to-T3 conversion. A guideline-supported oral regimen is 60 to 80 mg every 4 hours; for patients unable to take oral therapy, slow IV propranolol 1 to 3 mg at no more than 1 mg/minute followed, when needed, by infusion at 2 to 3 mg/hour has been described.[8]", "Before beta-blockade, assess for low-output heart failure, pulmonary edema, hypotension, shock, or occult thyrotoxic cardiomyopathy. In patients with known or suspected heart failure, use lower initial doses with invasive or close hemodynamic monitoring. Esmolol, with an approximately 9-minute half-life, is often preferred when rapid withdrawal may be needed: 500 mcg/kg IV over 1 minute, then 50 to 100 mcg/kg/minute.[8]", "Evidence on propranolol versus beta-1-selective agents is not definitive. A retrospective cohort found similar in-hospital mortality with propranolol and beta-1-selective beta-blockers, including among patients with acute heart failure. Nonetheless, cardiovascular collapse after beta-blockade has been reported, and recent case literature reinforces the need for cautious selection and titration.[8][22]" ], "bullets": [ "If beta-blockers are contraindicated by asthma or cardiac decompensation, diltiazem may be used for rate control.[8]", "Do not interpret persistent tachycardia as an automatic indication for escalating beta-blocker doses without reassessing cardiac output and shock physiology.[8][22]" ] } ], "table": { "caption": "Common ICU pharmacotherapy for thyroid storm; regimens and sequencing reflect cited guideline-based review recommendations.[8]", "columns": [ "Therapeutic target", "Preferred options and key safety point" ], "rows": [ [ "Adrenergic control", "Propranolol 60-80 mg orally every 4 hours; consider esmolol 500 mcg/kg IV over 1 minute then 50-100 mcg/kg/minute when hemodynamic reversibility is important.[8]" ], [ "Inhibit synthesis", "PTU 500-1,000 mg load then 250 mg every 4 hours, or methimazole 60-80 mg/day. PTU and methimazole had similar mortality and adverse events in a large observational cohort.[1][8]" ], [ "Inhibit release", "After at least 1 hour of thionamide: Lugol iodine 8 drops four times daily, SSKI 5 drops four times daily, or potassium iodide 65 mg three times daily.[8]" ], [ "Reduce conversion/adrenal support", "Hydrocortisone 300 mg IV load, then 100 mg IV every 8 hours; taper after improvement.[8]" ], [ "Increase clearance", "Cholestyramine 4 g three times daily is an off-label adjunct that interrupts enterohepatic hormone recirculation.[8]" ] ] } }, { "id": "refractory-disease-and-definitive-care", "eyebrow": "Escalation", "heading": "Escalate refractory storm and prevent recurrence", "intro": "Rescue therapies bridge unstable patients to definitive control when conventional treatment fails or is contraindicated.", "paragraphs": [ "Consider therapeutic plasma exchange when conventional therapy fails, when thionamides are contraindicated by severe adverse reactions or liver failure, or when rapid preoperative stabilization is required. Plasma exchange transiently lowers circulating thyroid hormones and cytokines; it is a bridge rather than definitive therapy.[3][8]", "Emergency thyroidectomy is generally deferred until medical stabilization because operative risk is substantial in uncontrolled thyrotoxicosis. It remains a rare option for refractory storm, severe antithyroid-drug intolerance, or urgent need for definitive hormone control after multidisciplinary assessment.[8]", "After recovery, continue antithyroid therapy and arrange definitive treatment planning, typically radioactive iodine or thyroidectomy, to reduce recurrent crisis risk. The appropriate modality depends on the underlying cause and patient factors; long-term management is outside the acute stabilization phase.[8]" ], "bullets": [ "Consider cholestyramine 4 g three times daily as an off-label adjunct when rapid hormone clearance is needed.[8]", "For persistent atrial fibrillation, assess thromboembolic risk and anticoagulation needs using established stroke-risk stratification rather than assuming thyrotoxicosis alone determines the decision.[8]" ], "subsections": [], "table": { "caption": "Escalation options for refractory thyroid storm.[3][8]", "columns": [ "Situation", "Escalation" ], "rows": [ [ "Persistent decompensation despite standard therapy", "Therapeutic plasma exchange to transiently remove circulating hormones and cytokines; coordinate with apheresis specialists.[3][8]" ], [ "Thionamide contraindication from severe adverse reaction or liver failure", "Plasma exchange as a bridge; pursue urgent definitive management planning.[8]" ], [ "Need for definitive rapid control after unsuccessful medical therapy", "Thyroidectomy only in rare, multidisciplinary-selected situations; routine surgery before medical control is not recommended.[8]" ] ] } }, { "id": "special-populations", "eyebrow": "High-risk settings", "heading": "Modify management for pregnancy, pediatric patients, and cardiac failure", "intro": "The general sequence remains similar, but drug and monitoring choices require additional caution.", "paragraphs": [ "Thyroid storm in pregnancy is rare but carries substantial maternal-fetal risk. Manage in an ICU with continuous cardiac and fetal monitoring and maternal-fetal medicine involvement. Diagnostic scoring systems have not been validated in pregnancy. PTU is preferred for acute storm treatment because of T4-to-T3 conversion inhibition; after stabilization, PTU is generally continued in the first trimester and methimazole is preferred later in pregnancy because of PTU hepatotoxicity and methimazole embryopathy considerations.[23]", "In pregnancy, esmolol is favored when beta-blockade is required in a potentially unstable patient because of its short half-life. Propranolol can be used if cardiac dysfunction is considered unlikely, but beta-blockers require caution because pregnant patients may be particularly vulnerable to heart failure and cardiogenic shock. Avoid atenolol because of fetal growth restriction concerns.[23]", "Children with thyrotoxicosis should be managed with pediatric endocrinology involvement. Thyroid storm remains a clinical diagnosis; adult scoring systems are not validated in children. Propylthiouracil is generally avoided in children outside exceptional circumstances because of fulminant hepatic failure risk.[5]" ], "bullets": [], "subsections": [], "table": { "caption": "Selected population-specific considerations.[5][23]", "columns": [ "Population", "Decision-critical modification" ], "rows": [ [ "Pregnancy", "ICU care with fetal monitoring; scoring systems are unvalidated. Use PTU acutely, then reassess trimester-specific antithyroid therapy after stabilization.[23]" ], [ "Pregnancy with uncertain cardiac reserve", "Favor titratable esmolol rather than prolonged beta-blockade; avoid atenolol.[23]" ], [ "Children", "Prompt pediatric endocrine consultation; adult storm scores are unvalidated and PTU is generally avoided because of fulminant hepatic failure risk.[5]" ], [ "Heart failure or shock", "Use cautious, low-dose, titratable beta-blockade with hemodynamic monitoring; evaluate for cardiomyopathy and cardiogenic shock.[8][22]" ] ] } } ], "faq": [ { "question": "Can thyroid hormone levels confirm or exclude thyroid storm?", "answer": "No. TSH is usually suppressed and free T4/T3 are elevated, but hormone concentrations overlap substantially with uncomplicated thyrotoxicosis. Diagnose storm from the severity of systemic decompensation and clinical context.[8]" }, { "question": "Should PTU always be preferred over methimazole in thyroid storm?", "answer": "PTU has an additional peripheral T4-to-T3 conversion effect and remains a traditional initial option, but a large multicenter observational cohort found no significant mortality or adverse-event difference from methimazole. Favor methimazole or carbimazole when significant liver dysfunction is present.[1][8]" }, { "question": "Why must iodine follow a thionamide?", "answer": "Iodine rapidly inhibits thyroid hormone release, but administered before synthesis blockade it can provide substrate for new hormone production, particularly in autonomous nodular thyroid disease. Give iodine at least 1 hour after a thionamide.[8]" }, { "question": "When should beta-blockers be avoided or modified?", "answer": "Reassess before use in hypotension, pulmonary edema, suspected low-output heart failure, cardiogenic shock, or thyrotoxic cardiomyopathy. Esmolol offers rapid discontinuation if hemodynamics worsen; diltiazem is an alternative when beta-blockers are contraindicated.[8][22]" }, { "question": "When is plasma exchange appropriate?", "answer": "Use plasma exchange selectively for refractory storm, contraindication to thionamides from severe toxicity or liver failure, or urgent preoperative stabilization. Its hormone-lowering effect is temporary and should bridge to definitive control.[3][8]" } ], "references": [ { "number": 1, "title": "Propylthiouracil vs Methimazole for Thyroid Storm in ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803923", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 2, "title": "THYROTOXIC CRISIS: An Analysis of the Thirty-Six Cases ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/294716", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 3, "title": "Thyroid Storm Treatment With Blood Exchange and ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/357871", "authors": "jamanetwork.com", "host": "jamanetwork.com" }, { "number": 4, "title": "Graves' disease - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/32", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com" }, { "number": 5, "title": "Notes for the general paediatrician: managing thyrotoxicosis in children and young people | BMJ Paediatrics Open", "detail": "bmjpaedsopen.bmj.com", "url": "https://bmjpaedsopen.bmj.com/content/6/1/e001582", "authors": "bmjpaedsopen.bmj.com", "host": "bmjpaedsopen.bmj.com" }, { "number": 6, "title": "Hyperthyroidism | Annals of Internal Medicine", "detail": "annals.org", "url": "https://annals.org/aim/article/doi/10.7326/AITC202004070", "authors": "annals.org", "host": "annals.org" }, { "number": 7, "title": "Screening for Thyroid Dysfunction: U.S. Preventive ...", "detail": "annals.org", "url": "https://annals.org/article.aspx?doi=10.7326%2FM15-0483", "authors": "annals.org", "host": "annals.org" }, { "number": 8, "title": "Approach to the patient with thyroid storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/111/5/1484/8467124", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 9, "title": "Perioperative management of the thyrotoxic... : Annals of Medicine & Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2022/09000/perioperative_management_of_the_thyrotoxic.160.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 10, "title": "Prospective Multicenter Registry–Based Study on Thyroid Storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/110/1/e87/7624230", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 11, "title": "Thyroid Storm Precipitated by Fine-needle Aspiration", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcemcr/article/3/9/luaf167/8221508", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 12, "title": "Clinical Features and Hospital Outcomes in Thyroid Storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/100/2/451/2813440", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 13, "title": "Potassium Iodide Use and Patient Outcomes for... : Journal of Clinical Endocrinology & Metabolism", "detail": "journals.lww.com", "url": "https://journals.lww.com/00004678-202502000-00040", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 14, "title": "Risk of perioperative thyroid storm in... : BJA: British Journal of Anaesthesia", "detail": "journals.lww.com", "url": "https://journals.lww.com/00002264-202112000-00011", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 15, "title": "Thyroid Storm in a Toddler Presenting as a Febrile Seizure", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/145/2/e20191920/68249/Thyroid-Storm-in-a-Toddler-Presenting-as-a-Febrile", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 16, "title": "27: Hyperthyroidism", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/edited-volume/736/chapter/11706144/Hyperthyroidism", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 17, "title": "Thyroid Emergencies", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/58372/cdc_58372_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov" }, { "number": 18, "title": "A rare case of thyroid storm - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4840694", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 19, "title": "Levothyroxine - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK539808", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 20, "title": "Antithyroid Drugs", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7393052", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 21, "title": "Levothyroxine - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK539808", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 22, "title": "A Case Report of Thyroid Storm with Cardiovascular Collapse After Propranolol Administration - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12594221", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 23, "title": "Thyroid storm in pregnancy: a review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10792856", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov" }, { "number": 24, "title": "Thyroid Storm - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK448095", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Propylthiouracil vs Methimazole for Thyroid Storm in ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803923", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by SY Lee · 2023 · Cited by 42 — Importance Thyroid storm is the most severe form of thyrotoxicosis, with high mortality, and is treated with propylthiouracil and methimazole.", "score": 0.12541868 }, { "number": 2, "title": "THYROTOXIC CRISIS: An Analysis of the Thirty-Six Cases ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/294716", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by JW McARTHUR · 1947 · Cited by 118 — Thyrotoxic crisis ('thyroid storm'), even with improved methods of treating hyperthyroidism, is by no means an extinct phenomenon. Of a total of 2033.", "score": 0.12261797 }, { "number": 3, "title": "Thyroid Storm Treatment With Blood Exchange and ...", "detail": "jamanetwork.com", "url": "https://jamanetwork.com/journals/jama/fullarticle/357871", "authors": "jamanetwork.com", "host": "jamanetwork.com", "snippet": "by FS Ashkar · 1970 · Cited by 191 — A striking improvement was observed in three patients after the use of blood exchange or plasmapheresis procedures when death appeared imminent", "score": 0.10415817 }, { "number": 4, "title": "Graves' disease - Symptoms, diagnosis and treatment | BMJ Best Practice", "detail": "bestpractice.bmj.com", "url": "https://bestpractice.bmj.com/topics/en-us/32", "authors": "bestpractice.bmj.com", "host": "bestpractice.bmj.com", "snippet": "### References\n\n#### Key articles\n\nRoss DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct;26(10):1343-421.Full textAbstract\n\nKahaly GJ, Bartalena L, Hegedüs L, et al. 2018", "score": 0.29606926 }, { "number": 5, "title": "Notes for the general paediatrician: managing thyrotoxicosis in children and young people | BMJ Paediatrics Open", "detail": "bmjpaedsopen.bmj.com", "url": "https://bmjpaedsopen.bmj.com/content/6/1/e001582", "authors": "bmjpaedsopen.bmj.com", "host": "bmjpaedsopen.bmj.com", "snippet": "thyrotoxicosis, such as a thyroid storm. This is a medical emergency with potential for life-threatening cardiovascular instability and a high mortality rate, estimated at 10%.6 In contrast to unhindered thyrotoxicosis, overtreatment, resulting in hypothyroidism, risks deceleration in growth and imp", "score": 0.2567439 }, { "number": 6, "title": "Hyperthyroidism | Annals of Internal Medicine", "detail": "annals.org", "url": "https://annals.org/aim/article/doi/10.7326/AITC202004070", "authors": "annals.org", "host": "annals.org", "snippet": "Hyperthyroidism is treated with antithyroid drugs, radioactive iodine ablation, or thyroidectomy. thyroid storm in the United States, 2004–2013.", "score": 0.3050453 }, { "number": 7, "title": "Screening for Thyroid Dysfunction: U.S. Preventive ...", "detail": "annals.org", "url": "https://annals.org/article.aspx?doi=10.7326%2FM15-0483", "authors": "annals.org", "host": "annals.org", "snippet": "The principal treatment for hypothyroidism is oral T4 monotherapy (levothyroxine sodium). Hyperthyroidism is treated with antithyroid medications", "score": 0.094719745 }, { "number": 8, "title": "Approach to the patient with thyroid storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/111/5/1484/8467124", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Given the mortality risk of untreated thyroid storm, clinical features such as goiter, high fever, marked tachycardia, and a precipitating illness warrant prompt treatment initiation even before test results become available. The treatment is multimodal and aims at reversing the severe systemic effe", "score": 0.54201555 }, { "number": 9, "title": "Perioperative management of the thyrotoxic... : Annals of Medicine & Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2022/09000/perioperative_management_of_the_thyrotoxic.160.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Himes CP, Ganesh R, Wight EC, Simha V, Liebow M, editors. Perioperative Evaluation and Management of Endocrine Disorders. 2020. Mayo Clinic proceedings. Elsevier.Cited Here \n Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J. Intensive Care Med. 2015;30(3):131-140.Cited Her", "score": 0.45449692 }, { "number": 10, "title": "Prospective Multicenter Registry–Based Study on Thyroid Storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/110/1/e87/7624230", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by Y Furukawa · 2025 · Cited by 24 — The guidelines include 14 recommendations for the treatment of thyrotoxicosis and organ failure in the central nervous system, cardiovascular", "score": 0.43655056 }, { "number": 11, "title": "Thyroid Storm Precipitated by Fine-needle Aspiration", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcemcr/article/3/9/luaf167/8221508", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Thyroid storm is a life-threatening syndrome caused by an exacerbation of thyrotoxicosis [3]. The diagnosis relies mainly on clinical", "score": 0.4295017 }, { "number": 12, "title": "Clinical Features and Hospital Outcomes in Thyroid Storm", "detail": "academic.oup.com", "url": "https://academic.oup.com/jcem/article/100/2/451/2813440", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "by TE Angell · 2015 · Cited by 186 — Thyroid storm (TS) is a rare but life-threatening manifestation of thyrotoxicosis. Predictive features and outcomes remain incompletely", "score": 0.3786894 }, { "number": 13, "title": "Potassium Iodide Use and Patient Outcomes for... : Journal of Clinical Endocrinology & Metabolism", "detail": "journals.lww.com", "url": "https://journals.lww.com/00004678-202502000-00040", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Advertisement\n\nOvid® Ovid Logo\n\nSearch Ovid Search Ovid\n\nBrowse Browse\n\nLogin Login\n\nThe Journal of Clinical Endocrinology & Metabolism\n\nNavbar\n\nMenu\n\n Current Issue \n Previous Issues \n Latest Articles \n\n More menu items \n\nSearch Journal Search Journal\n\nButton group.\n\n Check Access \n", "score": 0.18312602 }, { "number": 14, "title": "Risk of perioperative thyroid storm in... : BJA: British Journal of Anaesthesia", "detail": "journals.lww.com", "url": "https://journals.lww.com/00002264-202112000-00011", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Abstract\n\n# Abstract\n\n## Background:\n\nThyroid storm is a feared complication in patients with hyperthyroidism undergoing surgery. We assessed the risk of thyroid storm for different preoperative treatment options for patients with primary hyperthyroidism undergoing surgery.\n\n## Methods: [...] Advert", "score": 0.15119094 }, { "number": 15, "title": "Thyroid Storm in a Toddler Presenting as a Febrile Seizure", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/145/2/e20191920/68249/Thyroid-Storm-in-a-Toddler-Presenting-as-a-Febrile", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Once considered, the diagnosis of hyperthyroidism is easily made through blood tests revealing suppressed TSH with elevated FT4 and total T3.", "score": 0.39901572 }, { "number": 16, "title": "27: Hyperthyroidism", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/edited-volume/736/chapter/11706144/Hyperthyroidism", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "No specific laboratory workup is necessary to establish a diagnosis of thyroid storm. The diagnosis depends on the presence and severity of the signs and", "score": 0.34283602 }, { "number": 17, "title": "Thyroid Emergencies", "detail": "stacks.cdc.gov", "url": "https://stacks.cdc.gov/view/cdc/58372/cdc_58372_DS1.pdf", "authors": "stacks.cdc.gov", "host": "stacks.cdc.gov", "snippet": "Early diagnosis and prompt treatment, with meticulous attention to the details of management during the first 48 hours, remain critical for", "score": 0.22334355 }, { "number": 18, "title": "A rare case of thyroid storm - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC4840694", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Individual clinical drug trials of nivolumab and ipilimumab do not mention any cases of thyroid storm. Prescribing information does recommend monitoring thyroid function tests prior to and periodically during the course of treatment and medically managing adverse outcomes. There is currently no dose", "score": 0.54361504 }, { "number": 19, "title": "Levothyroxine - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/sites/books/NBK539808", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Administration\n\nMultiple dosage forms of levothyroxine are available, including oral tablets, capsules, solutions, and parenteral dosage forms. Specific instructions for the dosage forms are as below.\n\nAdult Dosing\n\nInfant and Pediatric Dosing\n\nMyxedema Coma (IV) or Severe Hypothyroidism\n\nOrgan R", "score": 0.43597415 }, { "number": 20, "title": "Antithyroid Drugs", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC7393052", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "In children and adolescents with GD, MMI is the preferred ATD with a daily dose in the range of 0.1-1 mg/kg. The ATA recommended approach for MMI prescription in patients aged ≤ 18 years is as follows: birth-1 year, 1.25 mg daily; 1-5 years, 2.5-5 mg daily; 5-10 years, 5-10 mg daily; and 10-18 years", "score": 0.42749292 }, { "number": 21, "title": "Levothyroxine - StatPearls - NCBI Bookshelf - NIH", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK539808", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "## Administration\n\nMultiple dosage forms of levothyroxine are available, including oral tablets, capsules, solutions, and parenteral dosage forms. Specific instructions for the dosage forms are as below.\n\nAdult Dosing\n\nInfant and Pediatric Dosing\n\nMyxedema Coma (IV) or Severe Hypothyroidism\n\nOrgan R", "score": 0.42305335 }, { "number": 22, "title": "A Case Report of Thyroid Storm with Cardiovascular Collapse After Propranolol Administration - PMC", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12594221", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "Three intraperitoneal drains were placed by interventional radiology on hospital day 8, and the patient was continued on IV antibiotics after abscess fluid cultures grew Pseudomonas aeruginosa. She also required continuous renal replacement therapy for acute kidney injury, which was transitioned to ", "score": 0.38221118 }, { "number": 23, "title": "Thyroid storm in pregnancy: a review", "detail": "pmc.ncbi.nlm.nih.gov", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC10792856", "authors": "pmc.ncbi.nlm.nih.gov", "host": "pmc.ncbi.nlm.nih.gov", "snippet": "#### Cholestyramine\n\nCholestyramine is a bile acid sequestrant that reduces the enterohepatic circulation of T4 and T3 and enhances their elimination. It is given orally in the dose of 4 g every 6 h . Cholestyramine interferes with the absorption of fat-soluble vitamins even in the presence of vitam", "score": 0.3584434 }, { "number": 24, "title": "Thyroid Storm - StatPearls - NCBI Bookshelf", "detail": "www.ncbi.nlm.nih.gov", "url": "https://www.ncbi.nlm.nih.gov/books/NBK448095", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Complete surgical resection of the thyroid and radioiodine ablation can cause hypothyroidism. So, these patients need lifetime exogenous thyroxine therapy and should be monitored for hyperthyroidism. Dose adjustments by endocrinologists are crucial as the patient is at risk of both hypothyroidism an", "score": 0.3534064 } ], "publishedAt": "2026-08-20T23:54:25.488837Z", "updatedAt": "2026-08-20T23:54:25.488837Z", "readingMinutes": 6, "slug": "thyroid-storm" }