Thyrotoxic Crisis or Thyroid Storm

Thyrotoxic crisis, thyroid storm, or accelerated hyper-thyroidism is an extreme accentuation of thyrotoxicosis. Although uncommon, this serious complication of hy-perthyroidism usually occurs in association with Grave's disease and occasionally with toxic multinodular goiter.

If unrecognized, it is invariably fatal. Thyroid storm is usually abrupt in onset and occurs in patients whose preexisting thyrotoxicosis has been treated incompletely or not at all. Thyrotoxic crisis may be related to cytokine release and an acute immunological disturbance caused by a precipitating condition, such as trauma, surgery, diabetic ketoacidosis, toxemia of pregnancy, or parturition. Although the serum thyroid hormone levels may not be appreciably greater than those in uncomplicated thyro-toxicosis, the clinical picture is severe hypermetabolism with fever, profuse sweating, tachycardia, arrhythmias, and so on. Pulmonary edema or congestive heart failure may also develop. With progression of the disorder, apathy, stupor, and coma may supervene, and hypotension can develop. There are no foolproof criteria by which severe thyrotoxicosis complicated by some other serious disease can be distinguished from thyrotoxic crisis induced by that disease. In any event, the differentiation between these alternatives is of no great significance because treatment of the two is the same, directed at systemic support and amelioration of the thyrotoxicosis.

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