Thyrotoxic Storm Following Thyroidectomy Workup

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

Laboratory Studies

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. [4] Laboratory findings in thyroid storm are consistent with those of thyrotoxicosis and include the following:

  • Elevated T3 and T4 levels

  • Elevated T3 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

  • Hyperglycemia