common report on patient having thyroid storm journal articles

Symptoms

Research Article: Clinical Case Report A thyroid storm patient with protracted disturbance of consciousness and reversible lesion in the splenium of corpus callosum A case report Namatame, Chihiro MD; Sonoo, Tomohiro MD*; Fukushima, Kazutaka MD; Naraba, Hiromu MD; Hashimoto, Hideki MD; Nakamura, Kensuke MD, PhD

Causes

Presentation of thyroid storm is an exaggerated manifestation of hyperthyroidism, with the presence of an acute precipitating factor. Fever, cardiovascular involvement (including tachycardia, heart failure, arrhythmia), central nervous system (CNS) manifestations, and gastrointestinal symptoms are common.

Prevention

The average age of people with thyroid storm was 42 to 43 years, which was similar to people with thyrotoxicosis without thyroid storm. The male to female ratio for the incidence of thyroid storm was about 1:3, similar to thyrotoxicosis without storm group. [4]  Pathophysiology

Complications

However, there is a subset of patients who fail medical management despite all of the most aggressive treatment modalities. This occurs more commonly in iodine-deficient areas, where thyroid storm is mostly related to iodine contamination in patients with thyroid autonomy.

What is the clinical case report for thyroid storm?

What are the signs and symptoms of thyroid storm?

What is the prevalence of thyroid storm?

Why do some patients fail medical management of thyroid storm?

What is the most common cause of thyroid storm?

Thyroid storm occurs due to a major stress such as trauma, heart attack, or infection in people with uncontrolled hyperthyroidism. In rare cases, thyroid storm can be caused by treatment of hyperthyroidism with radioactive iodine therapy for Graves disease.

What is the most common precipitating event for thyrotoxic crisis?

Thyroid storm is precipitated by the following factors in individuals with thyrotoxicosis:Withdrawal of or noncompliance with antithyroid medications.Diabetic ketoacidosis.Direct trauma to the thyroid gland.Vigorous palpation of an enlarged thyroid.Toxemia of pregnancy and labor in older adolescents; molar pregnancy.More items...

How common are thyroid storms?

Thyroid storm is rare. Its incidence in the United States is between 5.7 and 7.6 per one million people. However, thyroid storm can lead to acute heart failure and a buildup of fluid in the lungs. When it does occur, it can be life-threatening in around 10–25 percent of people with the condition.

Which finding is associated with thyroid storm?

Workup in thyroid storm Usual findings include elevated triiodothyronine (T3), thyroxine (T4), and free T4 levels; increased T3 resin uptake; suppressed thyroid-stimulating hormone (TSH) levels; and an elevated 24-hour iodine uptake.

What are complications of thyroid storm?

If left untreated, thyroid storm can lead to the following complications: Arrhythmias. High output cardiac failure. Seizures, delirium, coma.

What causes thyroid storm pathophysiology?

Any primary cause of hyperthyroidism can escalate into thyrotoxic crisis. There are triggers that can induce thyroid storm in patients with unrecognized thyrotoxicosis, which includes nonthyroidal surgery, parturition, major trauma, infection, or iodine exposure from radiocontrast dyes or amiodarone [27].

How is thyroid storm managed?

Through adequate rehydration, repletion of electrolytes, treatment of comorbid disease such as infection and the use of specific therapies (antithyroid drugs, iodine, beta-blockers and corticosteroids), a marked improvement in thyroid storm usually occurs within 24–72 hours.

What is thyroid storm Wikipedia?

Thyroid storm is a rare but severe and potentially life-threatening complication of hyperthyroidism (overactivity of the thyroid gland). It is characterized by a high fever (temperatures often above 40 °C/104 °F), fast and often irregular heart beat, elevated blood pressure, vomiting, diarrhea, and agitation.

What is the difference between thyroid storm and thyrotoxicosis?

Thyroid storm is rare and requires immediate medical attention. Thyrotoxicosis happens when you have too much thyroid hormone in your body in general. It can be caused by hyperthyroidism or other conditions like thyroiditis, which is when something causes your thyroid to leak thyroid hormone.

What happens in thyroid storm?

Thyroid storm is a life-threatening health condition that is associated with untreated or undertreated hyperthyroidism. During thyroid storm, an individual's heart rate, blood pressure, and body temperature can soar to dangerously high levels. Without prompt, aggressive treatment, thyroid storm is often fatal.

What are important nursing interventions for a patient presenting with thyroid storm?

Nursing Interventions for Thyroid StormMonitor HR, BP, RR (respiratory failure… may need mechanical ventilation), EKG, Temperature.Keep environment quiet and patient cool (cooling blankets and sedatives as prescribed)No foods containing iodine (seafood… seaweed, dairy, eggs)

What happens to your body during a thyroid storm?

A thyroid storm -- or thyroid crisis -- can be a life-threatening condition. It often includes a rapid heartbeat, fever, and even fainting. Your thyroid is a master at managing your body. The hormones produced by this gland located at the base of your neck help control your metabolism.

When was the thyroid storm first described?

Thyroid storm, an endocrine emergency first described in 1926, remains a diagnostic and therapeutic challenge. No laboratory abnormalities are specific to thyroid storm, and the available scoring system is based on the clinical criteria. The exact mechanisms underlying the development of thyroid storm from uncomplicated hyperthyroidism are not well ...

What is the mortality rate of thyroid storm?

Patients who fail medical therapy should be treated with therapeutic plasma exchange or thyroidectomy. The mortality of thyroid storm is currently reported at 10%.

Abstract

Thyroid storm (TS) is a rare but life-threatening manifestation of thyrotoxicosis. Predictive features and outcomes remain incompletely understood, in part because studies comparing TS with hospitalized thyrotoxic patients have rarely been performed.

Materials and Methods

After Institutional Review Board approval, consecutive records of adult patients admitted to LAC-USC from January 1, 2008, to December 31, 2013, with any ICD-9 diagnostic code for hyperthyroidism or thyrotoxicosis and an undetectable TSH level (<0.01 mIU/L) were retrospectively reviewed.

Results

During the 6-year study period, there were 170 034 acute hospital admissions to LAC-USC. Of 906 patients with a relevant ICD-9 diagnosis, 234 had a TSH <0.01 mIU/L. After exclusion of nonthyrotoxic patients (n = 44) and those with inadequate data (n = 40), 150 thyrotoxic patients were included, of which 25 were diagnosed with TS.

Discussion

Decompensated thyrotoxicosis, or TS, is frequently characterized by multiorgan system dysfunction and exaggerated manifestations of thyroid hormone excess ( 1, 6, 18 ), although sometimes presenting with a paucity of symptoms ( 19, 20 ).

Acknowledgments

Disclosure Summary: All authors have no conflicts of interest to declare.

What is a thyroid storm?

Thyroid storm (TS) is a rare condition characterized by an extreme, decompensated, life-threatening state of thyrotoxicosis. Diagnostic criteria for TS include, among other features, central nervous system (CNS) effects ranging from agitation to delirium, psychosis, or extreme lethargy to seizure or coma [ 1, 2 ]. Coma or even altered mentation has been reported to indicate a more serious outcome of TS [ 2–6 ]. Despite this, little is known regarding specific features or the effect of treatments on TS-related coma. For better understanding of this condition, a review of the English-language literature was performed to itemize individually reported cases with coexistent coma and TS, which were then evaluated in aggregate to describe the features, duration, treatment response, and prognosis of coma in the setting of TS.

How many cases of thyrotoxicosis with coma?

Sixty-five cases of thyrotoxicosis with coma were reported in English-language articles over 84 years between 1935 and 2019. Thirty-six cases were individually reported within small case series [ 3, 8–16 ], and 29 were reported as individual case reports [ 17–45 ]. The case series (1935 to 2011; median year, 1969) were published earlier than the individual cases (1951 to 2018; median year, 2000). Patients ranged in age from 3.5 to 87 years, with a mean age of 46 (SD, 20) years; 75% of the patients were female. Two patients had more than one episode of coma [ 32 ]; in one case, the patient recovered from TS-related coma but later died during the second episode of coma [ 22 ].

Is TS a poor prognosis?

Prognosis of coma associated with TS remains poor. Current guidelines for the early use of plasmapheresis in unresolving TS are advocated and should be considered urgently at the point of confusion or delirium in an effort to abort coma.

Goiter

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Abstract

Thyroid storm is a rare but life-threatening endocrine emergency. It is an acute exaggerated clinical manifestation of thyrotoxic state. The exact incidence is unknown. It occurs in 1–2% of patients admitted for thyrotoxicosis. It has a mortality of 10–20%.

1. Introduction

Thyroid storm, also known by its synonyms thyroid crisis, thyrotoxic storm, or thyrotoxic crisis, is an extremely rare but life-threatening endocrine emergency. It is an acute exaggerated clinical manifestation of thyrotoxic state [ 1 ]. It was first described by Frank Howard Lahey in 1926 as “the crisis of exophthalmic goiter” [ 2 ].

2. Epidemiology

Incidence of thyroid storm is not precisely known. Incidence in general population was reported as 0.57-0.76 per lac per year in USA and 0.20 per lac per year in Japan, whereas incidence in hospitalized patients was 4.8-5.6 per lac per year [ 4, 5, 6 ]. Hospital data suggest that it occurs in 1–2% of patients admitted for thyrotoxicosis [ 5 ].

3. Pathophysiology of storm

In order to understand the pathophysiology and rationale of treatment for thyroid storm, we need to understand the normal thyroid hormone physiology. Normal thyroid function is under control of feedback mechanisms between the hypothalamus, anterior pituitary and thyroid gland.

4. Triggers of thyroid storm

The transition from simple thyrotoxicosis to thyrotoxic crisis requires a superimposed insult. Any primary cause of hyperthyroidism can escalate into thyrotoxic crisis.

5. Clinical features and diagnosis

The diagnosis of thyroid storm is purely clinical, and if suspected, treatment should be initiated simultaneously without any delay. Clinical picture comprises of an exaggerated feature of hyperthyroidism accompanied by manifestations of multiorgan dysfunction, with the presence of an acute precipitating factor [ 46 ].

What is a thyroid storm?

Thyroid storm (TS), acute thyrotoxicosis originating from poorly controlled thyroid disease, is a life-threatening condition that usually requires intensive care. Various neurological manifestations are observed in 28.5% to 72% of TS cases,[1–3]but few patients fall into a coma.

Why is T3 abnormal?

Excess T3 in the central nervous system that can occur because of thyroid dysfunction is assumed to induce abnormal immunity in the central nervous system through these actions. These abnormal conditions of immune system are suggested as physiological mechanisms for Hashimoto encephalopathy.

Is SREAT normal?

In most cases of SREAT, the thyroid function is not associated with disease severity. Brain imaging is normal. Although this condition's pathophysiological mechanism has not been clarified, most cases of SREAT have been reported as showing good response to corticosteroid administration.

Does thyroid function improve after TS?

In contrast to our case, neurological dysfunction improves immediately after thyroid function improves in most TS cases. In these cases, thyroid hormone increases oxygen requirements by increasing the number of mitochondria.[5] Also in such cases, relative hypoxic states for the brain can occur temporarily.

Abstract

A thyroid storm is a severe exacerbation of thyrotoxicosis that can cause significant morbidity and mortality. The emergence of the novel coronavirus (SARS-CoV-2) that originated in Wuhan, China, has become a worldwide pandemic.

Introduction

A thyroid storm is defined as a life-threatening exacerbation of thyrotoxicosis, and is characterized by tachycardia, hyperthermia, agitation, altered mental status, and other organ system dysfunctions.

Case Report

A 25-year-old Hispanic woman with a medical history of obesity (body mass index, 32.0 kg/m 2 ), fatty liver disease, gastritis, and obstructive sleep apnea presented to the emergency room in Houston, Texas, in August 2020 with 1 week of intermittent shortness of breath and palpitations.

Discussion

Thyroid storms can be a diagnostic challenge as they are defined by largely clinical findings, and there are no universally accepted peer-reviewed criteria for diagnosis. 6 The point scale by Burch-Wartofsky is most widely used in the United States, but is empirically derived and may overdiagnose some cases of thyroid storm.

Abstract

Materials and Methods

Results

Discussion

Abbreviations

• Thyroid storm (TS) is a rare manifestation of thyrotoxicosis associated with substantial morbidity and mortality and requiring prompt recognition and treatment (1–5). A complete understanding of this condition remains difficult because of its rarity, nonspecific symptomatology, and variability in the diagnostic and treatment strategies applied. Tra...

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