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.

General examination  

Thorough general examination is mandatory in the assessment of any acutely unwell patient.

Temperature  

Pyrexia is a cardinal feature of thyroid storm.

Pulse, blood pressure and cardiovascular examination  

Tachycardia, atrial fibrillation and cardiac failure are key features of thyroid storm.

Abdominal examination  

Abdominal pain and jaundice may be associated with thyroid storm.

Full neurological examination

This is mandatory in a patient presenting with confusion or agitation to seek other underlying causes.

In the very unwell or uncooperative patient CNS examination this can be difficult but GCS and mini mental state assessment must always be documented as a bare minimum.