الثيرويد ستورم: الأعراض والتشخيص والعلاج

Definition and Causes

• Thyroid storm is a rare, life-threatening condition that occurs in patients with untreated or undertreated hyperthyroidism (an overactive thyroid gland)
• It is a severe exacerbation of hyperthyroidism, often triggered by a physiological stress such as:
  • Infection
  • Surgery
  • Trauma
  • Heart attack
  • Stroke
  • Diabetic ketoacidosis
  • Pulmonary embolism
  • Certain medications (e.g., amiodarone, lithium)

Symptoms

• Severe symptoms of hyperthyroidism, including:
  • Fever (usually high)
  • Tachycardia (rapid heart rate)
  • Tachypnea (rapid breathing rate)
  • Nervousness or anxiety
  • Tremors
  • Confusion or disorientation
  • Seizures (in rare cases)
• Additional symptoms that may occur:
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Headache
  • Weakness or fatigue

Diagnostic Criteria

• Burch and Wartofsky criteria:
  • Temperature >38.9°C (102°F)
  • Heart rate >130 beats per minute
  • Central nervous system dysfunction (e.g., confusion, seizures)
  • Gastrointestinal dysfunction (e.g., abdominal pain, vomiting)
  • Cardiovascular dysfunction (e.g., heart failure, tachyarrhythmias)
  • A diagnosis of hyperthyroidism or thyroiditis

Treatment

• Immediate hospitalization and intensive care unit (ICU) admission
• Supportive care:
  • Cooling measures to reduce fever
  • Fluid and electrolyte replacement
  • Oxygen therapy
  • Cardiovascular monitoring
• Antithyroid medications:
  • Thionamides (e.g., methimazole, propylthiouracil) to reduce thyroid hormone production
  • Beta-blockers (e.g., propranolol) to control symptoms and reduce heart rate
• Other medications:
  • Corticosteroids (e.g., hydrocortisone) to reduce inflammation
  • Aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce fever

Prognosis

• Mortality rate: 10-20% if left untreated
• With appropriate treatment, mortality rate decreases to 1-2%
• Prompt recognition and treatment are crucial to improve outcomes