Thyrotoxic Storm Following Thyroidectomy

Updated: Jan 21, 2015
  • Author: Peter F Czako, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Overview

Background

Thyroid storm is a clinical manifestation of an extreme hyperthyroid state that results in significant morbidity or disability or even death. Previously, thyroid storm was a common complication of toxic goiter surgery during intraoperative and postoperative stages. Preoperative control of the thyrotoxic state and use of radioiodine ablation has greatly reduced this phenomenon. Today, thyroid storm more commonly is seen in a thyrotoxic patient with intercurrent illness or surgical emergency. Early recognition and prompt intervention are necessary to prevail in management of this phenomenon.

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Epidemiology

Frequency

International

Presently, incidence is less than 10% among patients hospitalized for thyrotoxicosis.

Mortality/Morbidity

Thyroid storm, considered a fulminating state, is fatal when untreated.

Although methods of diagnosis and management have improved considerably, reported mortality still is 20-30%.

Although it can develop in toxic adenoma or multinodular toxic goiter, thyroid storm is more commonly seen in toxicity secondary to Graves disease. See the image below.

Pathophysiologic mechanisms of Graves disease rela Pathophysiologic mechanisms of Graves disease relating thyroid-stimulating immunoglobulins to hyperthyroidism and ophthalmopathy. T4 is levothyroxine. T3 is triiodothyronine.

Sex

Age and sex predilection depends on the etiology of thyrotoxicity. Graves disease more frequently develops in females (ie, male-to-female ratio ranges from 1:7 to 1:10); multinodular goiter more often manifests in the elderly population.

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