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Thyroid Storm Treatment, Causes, symptoms, and Diagnosis

Thyroid storm is a complicated form of Hyperthyroidism, it is a rare and life-threatening medical condition that needs emergency attention. Common symptoms are persistent sweating, heart failure, confusion, and high fever. The patient feels better after the immediate treatment in the hospital's emergency room.  

What is a thyroid storm?

A Thyroid storm is life-threatening and a rare complication of Hyperthyroidism. It’s also called a thyroid crisis or thyrotoxic crisis. This medical condition happens when the thyroid gland secretes a huge amount of thyroid hormone in a short time period. A thyroid storm is a health emergency, and without insistent and quick treatment, it may cause death.

What does thyroid do?

A thyroid is a butterfly-shaped gland situated in the middle of the neck. The thyroid gland produces two types of significant hormones T3 (Triiodothyronine) and T4 (Thyroxine), that help the growth and body functions. The thyroid gland plays a significant role in several main body functions.

A thyroid is a butterfly-shaped gland situated in the middle of the neck. 

The thyroid gland produces two types of significant hormones T3 (Triiodothyronine) and T4 (Thyroxine), that help the growth and body functions. The thyroid gland plays a significant role in several main body functions.

T3 and T4 together are called thyroid hormones, and these hormones regulate the body temperature and control the metabolism and heart rate. 

The person, who has a thyroid storm, the huge amount of thyroid hormones in the body releases the metabolism at a high speed that is dangerous and fatal.

When a person has hyperthyroidism, the thyroid produces a very high amount of thyroid hormone (T3 and T4), which turns out cells to work too quickly. For example, heart rate and respiration rate will be elevated than normal would be. A person may speak more quickly than usual.

When there is forceful metabolism activity, the body needs additional oxygen, the heartbeat gets fast called tachycardia which may cause heart failure.

How common is the thyroid storm?

A Thyroid storm is not a common but rare medical emergency, in the United States, around five to seven individuals per 1 million people get a thyroid storm.

Does thyroid storm come suddenly?

As thyroid storm is a rare complication of hyperthyroidism, which may fatal, in this condition thyroid suddenly produces a large amount of thyroid hormones in a short period of time. The thyroid storm needs quick medical attention.

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What causes a 

thyroid storm?

Health experts are not so far sure about the definite factors that turn out in a thyroid storm. Even though, a thyroid storm may develop if anyone is not treated or undertreated for hyperthyroidism for a long time. It’s repeatedly caused by a sudden and acute condition. But not all hyperthyroidism cases experience thyroid storm.

These sudden conditions are

  • Thyroidectomy (Thyroid surgery)
  • Suddenly stop taking antithyroid medication
  • Trauma
  • Nonthyroid surgery
  • Infection associated with hyperthyroidism
  • Acute diseases, such as heart failure, diabetic ketoacidosis (KDA), and drug reaction.
  • Stroke 
  • Pregnancy
  • A rapidly large amount of iodine enters the body, for example, in certain imaging procedures that are used, iodinated contrast agents.  

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Who gets a thyroid storm?

As thyroid storm is complicated hyperthyroidism, an individual who has a condition that turns out hyperthyroidism, for example, toxic thyroid adenoma, or Grave’s disease, is more on the verge of getting thyroid storm. Like with all thyroid disorders, women and individuals allocated female at birth are more prone to get thyroid storm than men allocated male at birth. The usual age of an individual who experiences thyroid storm is in between 42-43 years.

What does thyroid storm feel like?

While thyroid hormones participate in many body functions, if anyone gets thyroid storm in general he will feel pretty bad all over, and he may experience

  • Very anxious or agitated
  • Very sweaty and hot
  • Sick to stomach
  • Shaky
  • Feel like he does not have control over his body
  • Confusion 
  • Unconsciousness

If anybody is experiencing one of these symptoms, an immediate appointment and checkup is necessary to get back to the normal life.


What are the signs and symptoms of thyroid storm?

Signs and symptoms of thyroid storm are as similar to hyperthyroidism patient experiences but, they are more intense, abrupt, and rigorous, that’s why patients with thyroid storm can’t seek care on their own.

Common signs and symptoms are

  • Persistent sweating
  • Rapid heart rate called tachycardia that can go above 140 beats /minute.
  • High fever. A temperature may between 104 to 106 degrees Fahrenheit    
  • Congestive heart failure
  • Restlessness
  • Confusion
  • Unconsciousness
  • Shaking
Less common signs and symptoms are
  • Abdominal pain
  • Severe nausea and/or vomiting
  • Jaundice (Yellowish eyes and skin)
  • Diarrhea 

What is the first thing to do during a thyroid storm?

If you expect you have a thyroid storm by experiencing the symptoms of a thyroid storm for example elevated heart rate, or high blood pressure, immediately make a call to 911. Your healthcare providers will measure your thyroid hormone levels with a thyroid blood test.

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How thyroid storm is diagnosed?

A person who shows any symptom of thyroid storm is usually admitted to the emergency room after the healthcare provider’s recommendations. A patient with a thyroid storm usually exhibits high blood pressure as well as an elevated heart rate.

Healthcare providers also practice the physical examination to observe the sign of thyroid storms such as

  • Ophthalmopathy, which is a complicated condition of Grave’s disease, is associated with eye problems, for example, bulging and swollen eyes.
  • Moist and warm skin
  • Tachycardia or atrial fibrillation
  • Hand tremors
  • Lid lag, in which the patient’s upper eyelid is higher than it should be when looking down.
  • Management and Treatment


How thyroid 

storm is treated?

If an individual experiences symptoms of a thyroid storm like tachycardia, hand tremors, lid lag or confusion, or other symptom mentioned above, it is significant to get to the nearest hospital as soon as possible because this is a life-threatening medical emergency.

The treatment strategies suggested by healthcare providers are divided into 4 common groups, which include

  • Treatment for the patient’s body system and tissues for example heart is affected by the high amounts of thyroid hormones.
  • Embattled treatment, works in opposition to the making and production of thyroid hormones. Antithyroid medications such as methimazole also called Tapazole, and propylthiouracil also known as PTU, are usually given to decrease the making of thyroid hormones.
  • Treatment of the condition or disease that turned out thyroid storm
  • Other supportive treatment strategies to assist with side effects and symptoms.

Treatment and medication therapies for thyroid storm may comprise

  • Beta-blockers to deal with symptoms
  • Antithyroid medicines like thioamides stop the thyroid from producing new thyroid hormones.
  • Use iodine solution, to prevent the thyroid from producing hormones.
  • Use Bile acid sequestrants to stop the gut from reabsorbing thyroid hormones.
  • Respiratory treatment, for example, supplemental oxygen
  • Cooling blankets and acetaminophen to lower the patient’s temperature
  • An individual having a thyroid storm is probably in ICU (Intensive care Unit) in the hospital so the healthcare provider's team can supervise the treatment and symptoms repeatedly.
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How soon will I better after treatment for thyroid storm?

If you get accurate medical treatment, you will probably feel well again within 24 hours. It will take up to about 7 days to treat your thyroid storm. 


Can I prevent 

thyroid storm?

The most efficient way to prevent the commencement of a thyroid storm is to maintain your thyroid health plan. Take your medication strictly prescribed by your healthcare providers. Keep all the appointments with healthcare providers and follow throughout with blood work orders as required.

Most cases of thyroid storm are preventable, but if you have hyperthyroidism, healthcare providers suggested some things you can do to try to stop or prevent thyroid storm, including

  • Visiting your healthcare providers on a regular basis to make sure your treatment is going well.
  • Constantly taking your medicines prescribed by healthcare providers.
  • Due to the body’s stress response to anesthesia or surgery thyroid stress may develop. That’s why healthcare providers prescribed antithyroid medicines before surgery in order to prevent thyroid storm.

Long term outlook:

As a thyroid storm is a life-threatening medical emergency, it requires urgent, aggressive medical attention. It can cause congestive heart failure or fluid-filled lungs if left untreated. However, within 24 hours of treatment, most people experience improvement.

The possibility of surviving a thyroid storm elevates if quick medical care is provided. When thyroid hormone levels returned back to the normal range, related complications may be decreased. 

The death rate for individuals with untreated thyroid storm is approximately to be 75%.

Risks issues for a bad prognosis are 

  • If an individual, has neurological problems on admission to a hospital, for example, lessened mental function and sensation problems.
  • If an individual of old age
  • If an individual needs mechanical ventilation (breathing through the machine) or/and dialysis to treat thyroid storm.
  • Due to some health conditions, healthcare providers are unable to use antithyroid and beta-blockers medicines to treat thyroid storm. 

Can thyroid storm be fetal?

A thyroid storm is an emergency condition that can be fatal, if it’s not treated on time. Even it can be fatal with treatment. About 10-30% of cases of thyroid storm result in death. 

It is necessary to reach the hospital as soon as possible if someone exhibits symptoms of thyroid storm, don’t wait for symptoms to get worse.


What are the 

complications of 

thyroid storm?

As discussed above thyroid storm may result in serious complications if treatment is interrupted or it’s untreated, including:

  • Seizures
  • Blood clots
  • Cardiac failure (Heart attack)
  • Delirium
  • Coma


Q1: What triggers thyroid storm?

  • Most of the time thyroid storm happens in individuals with uncontrolled hyperthyroidism due to stress, for example, infections, heart attack, trauma, etc.

Q2: What is the first line treatment for thyroid storm?

  • Tachycardia is the major and serious symptom of Thyroid Storm, so bisoprolol (given orally) or Beta-1-selective adrenergic antagonists such as esmolol, and, landiolol (given intravenously) will be the first choice of treatment of Thyroid Storm.

Q3: What medication is administrated for thyroid storm?

  • Generally, in medical practice, 100 mg of hydrocortisone after every 6-hour gap intramuscular (IM) or intravenous (IV) is given until the resolution of the thyroid storm. Treatment would be tapered properly depending on the required time period of steroid therapy.


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