Thyroid Storm: Symptoms, Causes, Diagnosis, Treatment

Thyroid Storm: Symptoms, Causes, Diagnosis, Treatment


A thyroid storm is a rare but potentially life-threatening condition that occurs when you get a surge of thyroid hormones that speed up your metabolism. The most common trigger of this condition is untreated hyperthyroidism (overactive thyroid), or thyrotoxicosis.

If you’re experiencing a thyroid storm, you may develop symptoms such as a fever, rapid heartbeat, and high blood pressure. Because this condition is serious, it’s essential to receive treatment as soon as possible to avoid complications.

A thyroid storm puts your body’s metabolism into overdrive. Symptoms can often develop suddenly and get severe quickly, requiring immediate medical attention. The following signs may indicate that you or a loved one are experiencing a thyroid storm:

  • Hypertension (high blood pressure)
  • High fever, usually above 104 degrees Fahrenheit (40 degrees Celsius)
  • Heart palpitations
  • Chest pain
  • Tachycardia (rapid heartbeat)
  • Agitation or confusion
  • Abdominal pain, which may sometimes lead to diarrhea or vomiting
  • Fluid in the lungs
  • Excessive sweating
  • Swelling or tremors in the hands and feet
  • Dizziness or fainting
  • Shortness of breath
  • Jaundice

Your thyroid is a tiny butterfly-shaped gland in your neck that makes hormones that control your energy, heart rate, and temperature. Hyperthyroidism occurs when an overactive thyroid causes high thyroid hormone levels. This can occur due to:

  • Graves’ disease, an autoimmune disorder
  • Thyroid nodules or tumors
  • Goiter, or the enlargement of the thyroid
  • Thyroiditis, or inflammation of the thyroid
  • Too much iodine intake 
  • Pituitary disorders or tumors

If you have hyperthyroidism and miss your medications or experience a trigger, your thyroid pumps out a surge of excess hormones, which can sometimes lead to a thyroid storm. This puts your body into overdrive, making you burn energy and use oxygen too fast. Experts believe it’s not just the high hormone levels your body produces but the sudden surge of these hormones that makes a thyroid storm especially serious. 

Triggers

Having hyperthyroidism alone isn’t enough to cause a thyroid storm. If you’re experiencing a thyroid storm, it’s likely because something triggered the surge of hormones. Common triggers include: 

  • Not taking thyroid medications properly
  • Physical injuries, accidents, or burns
  • Childbirth or pregnancy complications
  • Diabetic ketoacidosis
  • Extreme emotional distress
  • Heart attack or heart failure
  • Infections 
  • Stroke or traumatic brain injury
  • Undergoing surgery or getting radioactive iodine therapy

Risk Factors

Some people with hyperthyroidism may be at a higher risk of developing a thyroid storm than others. The most common risk factor is untreated hyperthyroidism, which occurs if you’re not receiving treatment for your condition or if you’re not taking prescribed medications properly.

Having a family history of thyroid disease and being assigned female at birth can also increase your risk of experiencing a thyroid storm.

If you’re experiencing a thyroid storm, it’s essential to seek support from a healthcare provider as soon as possible to avoid the risk of complications. When you see a provider, they’ll check your medical history, ask about your symptoms, measure your vital signs (e.g., blood pressure and heart rate), and perform a physical exam. They may also order tests to identify what’s causing your condition and confirm a thyroid storm diagnosis, such as:

  • Complete blood count (CBC): Checks red blood cells, platelets, and markers of infection, like a high white blood cell count
  • Electrocardiogram (ECG): Records the heart’s electrical activity to identify any heart problems
  • Chemistry or metabolic panel: Measures blood glucose (sugar) and electrolytes like calcium, potassium, and sodium
  • Imaging scan: Uses tests like ultrasounds, chest X-rays, or computed tomography (CT scans) to assess inflammation or abnormalities in your head, neck, or chest
  • Liver function test: Checks liver enzyme and protein levels
  • Thyroid function test: Assesses thyroid stimulating hormone (TSH), T3, and T4 levels in your body 

Your provider might also use the Burch-Wartofsky Point Scale (BWPS) or the Japanese Thyroid Association (JTA) clinical scoring systems to gauge the severity of a thyroid storm. These scales assign a score based on your symptoms and diagnostic tests.

For a thyroid storm, immediate treatment is crucial to stabilize you and prevent complications. Your healthcare provider may recommend several medications:

  • Beta-blockers: Inderal (propranolol) can relieve symptoms like a high heart rate, tremors, and anxiety.
  • Glucocorticoids: Deltasone (prednisone) or Decadron (dexamethasone) help reduce swelling and thyroid hormone release.
  • Iodine: Potassium iodide and Lugol’s solution may lower thyroid hormone levels.
  • Potassium perchlorate (KClO4): This inorganic salt that helps treat hyperthyroidism that was caused by Pacerone (amiodarone), a medication that treats arrhythmia (irregular heartbeat).
  • Questran (cholestyramine): This helps lower cholesterol and reduce thyroid hormone levels.
  • Thionamides: Propyl-Thyracil (PTU) or Tapazole (methimazole) reduce thyroid hormone production.
  • Priadel (lithium): This limits how much thyroid hormones your body can produce but is only used when other medications haven’t been helpful.

If thyroid medications aren’t improving your symptoms, your healthcare provider may recommend other options. These may include antibiotics to treat underlying infections, hydration, IV fluids, and oxygen therapy to relieve symptoms, or a thyroidectomy to remove the thyroid gland. Generally, a thyroidectomy is only needed in very severe cases.

Having a thyroid storm might seem scary, but there are ways to reduce the chances of it happening. The most important thing is consistently taking your thyroid medication exactly as your healthcare provider prescribes. Seeing your provider regularly also lets them monitor your thyroid levels so they can adjust your medication when necessary. 

If you’re going to have surgery or are feeling sick, make sure to tell your provider and seek urgent treatment for underlying causes like infection. Some people also wear a bracelet that says they have hyperthyroidism, just in case of an emergency.

A thyroid storm is a potentially life-threatening condition that requires emergency medical care. While it is reversible with early and proper treatment, delayed treatment can lead to complications such as:

A thyroid storm is a rare and life-threatening condition that can occur with untreated or poorly managed hyperthyroidism (overactive thyroid). Symptoms may include a high fever, rapid heart rate, and high blood pressure, among other signs. Fortunately, a quick diagnosis and treatment can prevent complications and help you feel better soon.

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