Thyroid storm

Thyroid storm refers to the life threatening acute presentation of thyroid hormone excess of any cause, typified by pyrexia, tachycardia, neurological disturbance, gastrointestinal upset and heart failure.

Is the patient known to have thyroid disease?  

Thyroid storm usually occurs in people with long standing thyrotoxicosis.

Does the patient describe typical symptoms of thyrotoxicosis?

If the patient is not known already to have thyroid disease, ask about heat intolerance, tremor, palpitations, weight loss, diarrhoea and other typical features if thyrotoxicosis.

Has the patient stopped or changed their medication recently?  

Storm may be precipitated by withdrawal of anti-thyroid drugs.

Has the patient received radioactive iodine or a contrast enhanced CT scan recently?

Iodinated contrast medium or indeed radioactive iodine may precipitate storm.

Has the patient undergone recent surgery?  

Surgery and anaesthesia are recognised triggers for thyroid storms.

Does the patient have any other obvious medical problems?  

Storm may be precipitated by any major insult e.g. myocardial infarction, stroke, severe infection, etc.

Does the patient complain of palpitations, chest pain or breathlessness?  

Tachycardia, atrial fibrillation and heart failure may all occur as part of thyroid storm and are necessary to score this condition.

Myocardial infarction is also a recognised trigger for thyroid storm.

Does the patient feel very hot?  

Pyrexia is a cardinal feature of thyroid storm and its documentation is necessary to score this condition.

Does the patient complain of abdominal pain?

Abdominal pain, abnormal liver function and jaundice may all occur as part of thyroid storm and are necessary to score this condition.

Does the patient appear confused or agitated?  

CNS disturbance isn't key feature of thyroid storm and should be documented to help score this condition.