Thyroid Storm Clinical Presentation

Updated: Jan 18, 2022
  • Author: Madhusmita Misra, MD, MPH; Chief Editor: Robert P Hoffman, MD  more...
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Patients may have a known history of thyrotoxicosis. In the absence of previously diagnosed thyrotoxicosis, the history may include symptoms such as irritability, agitation, emotional lability, a voracious appetite with poor weight gain, excessive sweating and heat intolerance, and poor school performance caused by decreased attention span. Burch and Wartofsky have published precise criteria and a scoring system for the diagnosis of thyroid storm based on clinical features. [2]

  • General symptoms

    • Fever

    • Profuse sweating

    • Poor feeding and weight loss

    • Respiratory distress

    • Fatigue (more common in older adolescents)

  • GI symptoms

    • Nausea and vomiting

    • Diarrhea

    • Abdominal pain

    • Jaundice [3]

  • Neurologic symptoms

    • Anxiety (more common in older adolescents)

    • Altered behavior

    • Seizures, coma


Physical Examination

Physical findings include the following:

  • Fever

    • Temperature consistently exceeds 38.5°C.

    • Patients may progress to hyperpyrexia.

    • Temperature frequently exceeds 41°C.

  • Excessive sweating

  • Cardiovascular signs

    • Hypertension with wide pulse pressure

    • Hypotension in later stages with shock

    • Tachycardia disproportionate to fever

    • Signs of high-output heart failure

    • Cardiac arrhythmia (Supraventricular arrhythmias are more common, [eg, atrial flutter and fibrillation], but ventricular tachycardia may also occur.)

  • Neurologic signs

    • Agitation and confusion

    • Hyperreflexia and transient pyramidal signs

    • Tremors, seizures

    • Coma

  • Signs of thyrotoxicosis

    • Orbital signs

    • Goiter

  • Rhabdomyolysis - Rare cases have been reported following a diagnosis of thyroid storm in adults [17]



Complications of thyroid storm include:

  • High output cardiac failure
  • Cardiac arrhythmias
  • Delirium, seizures, coma
  • Abdominal pain, diarrhea, vomiting, jaundice
  • Elevation of transaminases

A study by Mohananey et al found that out of 41,835 US patients with thyroid storm, 1% developed cardiogenic shock, with the incidence of this complication in these patients rising between 2003 and 2011 from 0.5% to 3%. However, during this same period the mortality rate from cardiogenic shock in patients with thyroid storm decreased from 60.5% to 20.9%. The highest likelihood of cardiogenic shock was in male patients with preexisting atherosclerotic or structural heart disease. [18]