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.
Thyroid storm can only be diagnosed in the presence of severe biochemical thyrotoxicosis: a completely suppressed TSH with a thyroxine level typically over 45miU/L.
Renal function must be documented at presentation as dehydration often occurs with thyroid storm and can cause acute kidney injury.
Hyponatraemia and hyperkaleamia would increase suspicion for adrenocortical deficiency.
A septic screen should be performed in all patients presenting acutely unwell, with tachycardia and pyrexia.
Liver function will often be abnormal with thyrotoxicosis.
It is part of the scoring system to diagnose storm, and should also be documented prior to the commencement of anti-thyroid drugs.
Glucose levels should be monitored at presentation and four hourly during acute treatment.
Diabetic ketoacidosis is also a recognised trigger for thyroid storm.
Hypercalcaemia may associate severe thyrotoxicosis.
A trigger for thyroid storm should be sought in all cases.
A septic screen should also be performed in all patients presenting acutely unwell, with tachycardia and pyrexia.
Thyroid storm is most commonly associated with autoimmune rather than nodular thyroid disease and treatment usually involves steroids. It may therefore be useful to send a random cortisol at presentation.
ECG is mandatory in the acutely unwell patient with tachycardia and to confirm atrial fibrillation.
Useful to confirm pulmonary oedema if cardiac failure is suspected.
A septic screen should also be performed in all patients presenting acutely unwell, with tachycardia and pyrexia which should include a chest radiograph.
Useful to confirm pulmonary oedema if cardiac failure is suspected.
A septic screen should also be performed in all patients presenting acutely unwell, with tachycardia and pyrexia which should include a chest radiograph.
Often necessary to exclude other acute causes of confusion or altered GCS.
Myocardial infarction is a recognised trigger for thyroid storm. Cardiac enzymes should be checked if clinical suspicion is high or with an abnormal ECG.