Thyrotoxic Storm Following Thyroidectomy Workup
- Author: Peter F Czako, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA more...
Presently, no specific diagnostic criteria to establish the diagnosis of thyroid storm exist.
Burch and Wartofsky have constructed an excellent clinical diagnostic point scale to facilitate a semiquantitative distinction between uncomplicated thyrotoxicosis, impending storm, and established thyroid storm. Laboratory findings in thyroid storm are consistent with those of thyrotoxicosis and include the following:
Elevated T 3 and T 4 levels
Elevated T 3 uptake
Suppressed TSH levels
Elevated 24-hour radioiodine uptake
Elevated T4 and decreased TSH are the only abnormal findings needed for conformation of thyrotoxicosis. Treatment should not be withheld for any laboratory confirmation of hyperthyroidism when thyroid storm is suspected clinically. A 2-hour radioiodine uptake is advisable if thyroid storm is suspected and no past history of hyperthyroidism exists.
Other abnormal laboratory values that point toward decompensation of homeostasis include the following:
Increased BUN and creatinine kinase
Electrolyte imbalance from dehydration, anemia, thrombocytopenia, and leukocytosis
Hepatocellular dysfunction as shown by elevated levels of transaminases, lactate dehydrogenase, alkaline phosphatase, and bilirubin
Elevated calcium levels
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|Uncomplicated Thyrotoxicosis||Thyroid Storm|
|1. Heat intolerance, diaphoresis||1. Hyperpyrexia, temperature in excess of 106o C, dehydration|
|2. Sinus tachycardia, heart rate 100-140||2. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure|
|3. Diarrhea, increased appetite with loss of weight||3. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction-jaundice|
|4. Anxiety, restlessness||4. Confusion, agitation, delirium, frank psychosis, seizures, stupor or coma|