Thyroid disease is a lifelong condition affecting nearly 20 million people in the United States. Fortunately, when properly diagnosed and treated, thyroid dysfunction can be managed. However, an unidentified or improperly treated thyroid issue may develop into a life-threatening condition known as thyroid storm. Having a greater understanding of thyroid storm can help protect those with thyroid disease from a potentially catastrophic event.
What is the Thyroid?
Before discussing thyroid disease, we must first discuss the important role of the thyroid. The thyroid is a small gland located near the front of the neck that regulates numerous bodily functions. It does this primarily through the production of two hormones; active thyroid hormone, triiodothyronine (T3) and inactive thyroid hormone, thyroxine (T4). These and other hormones influence metabolism and by extension the activity of virtually every cell and tissue in the body. Therefore, it is critical that thyroid function and hormones like T3 and T4 be maintained at the appropriate values.
What is Thyroid Storm?
There are two primary ways in which the thyroid malfunctions; hypothyroidism and hyperthyroidism. Hyperthyroidism describes an overactive thyroid which triggers an unhealthy acceleration of metabolic function and bodily activity. Such an increase in activity can result in a hastened heart rate, elevated blood pressure, jitteriness and anxiety, and other symptoms. If left unattended for an extended period, hyperthyroidism may result in a potentially life-threatening condition known as a thyroid storm.
Thyroid storm is a term used to describe a severe form of thyrotoxicosis, or dangerously elevated values of thyroid hormone and accelerated thyroid activity. Although hyperthyroidism is a requisite component of a thyroid storm, many patients with hyperthyroidism never experience thyroid storm.
When a thyroid storm occurs, it is essential that appropriate treatment be employed as soon as possible. If the response is too tepid or slow, a thyroid storm can easily lead to fatality. It is estimated that the mortality rate for thyroid storms rests between 10 and 20 percent. One of the best ways of limiting the fatalistic nature of a thyroid thyroid storm is by identifying signs and symptoms as early as possible.
Signs of an Oncoming Thyroid Storm
Treating a thyroid storm requires immediate action. Therefore, it is of critical importance that you be able to quickly recognize the signs and symptoms of an oncoming episode. Being familiar with the following indicators of thyroid storm may improve response time and could even safe a life.
Most symptoms of thyroid storm are shared with hyperthyroidism. However, symptoms of thyroid storm often appear suddenly and at much greater intensity than those produced by general hyperthyroidism. Symptoms of a thyroid storm include:
- Accelerated heart rate (anything above 140 beats per minute is a major concern)
- Atrial fibrillation
- Elevated temperature or fever
- Persistent sweating
- Irritation or moodiness
- Passing out
- Nausea or vomiting
Most cases can be accurately diagnosed through symptoms alone. But if severe symptoms are not enough of an indicator, doctors may also assess thyroid function through a blood test. The standard practice for assessing the thyroid involves testing thyroid stimulating hormone (TSH) values. Typically, TSH values are low among those with hyperthyroidism and people going through a thyroid storm. However, TSH can be inaccurate regarding actual thyroid activity. Therefore, it is best to also include other thyroid hormones such as T3 and T4 when assessing thyroid function. The most reliable indicator of a thyroid storm is exceptionally high values of T3 and T4. This strongly suggests excess thyroid activity and potential for storm.
Possible Causes of Thyroid Storm
Hyperthyroidism is the leading cause of thyroid storm. However, an autoimmune thyroid condition known as Graves’ disease, the leading cause of hyperthyroidism, is also a common instigator – learn more about Graves’ disease here. Regardless of the cause of hyperthyroidism, the greatest risk factor of a thyroid storm is a lack of diagnosis and treatment. The longer that hyperthyroidism goes unidentified and untreated the greater the likelihood of a thyroid storm.
Typically, those with hyperthyroidism or Graves’ disease do not develop a thyroid storm without some other trigger. The following conditions or events can aggravate thyroid function to a degree that initiates a thyroid storm:
- Certain ovarian or testicular tumors
- Congestive heart failure
- Damage to the thyroid gland
- Diabetic ketoacidosis
- Ingesting too much thyroid medication
- Iodine supplements or tests that use iodine
- Major emotional stressor
- Physical or emotional trauma
- Pulmonary embolism (clotting in the lungs)
- Thyroid nodules
- Viral infections
How to Treat and Prevent Thyroid Storms
Treatment for a thyroid storm should begin as soon as possible after the condition has been identified or diagnosed. It is often the case that treatment is administered before lab tests are completed due to the need for immediate action.
The primary goals when treating a thyroid storm are reducing the production of thyroid hormones, limiting release of thyroid hormones, slowing thyroid hormone activity, and managing current symptoms. There are multiple approaches to accomplishing these goals, each having their own place, benefits, and drawbacks:
- Corticosteroids may be used to reduce conversion of inactive thyroid hormone (T4) into active hormone (T3)
- Lithium carbonate may be administered on a strict schedule and dosage to limit thyroid hormone release and iodination. However, there are risks of toxicity associated with this approach
- Radioactive iodine treatments may be administered to intentionally damage or destroy the thyroid gland to limit hormone release
- Antithyroid drugs may be supplied to temporarily suppress thyroid function until values have stabilized
- Pregnant patients or individuals with other health complications may require surgical removal of the thyroid gland or thyroidectomy to halt thyrotoxicosis
Once the initial threat of a thyroid storm has been resolved any other complications or contributing factors may be attended.
Using Your Knowledge to Safely Navigate Thyroid Storms
Thyroid disease, such as hyperthyroidism, is a serious health issue. But if it is properly diagnosed and treated it poses little threat. However, hyperthyroidism that goes unnoticed or is not treated properly can develop into a potentially life-threatening thyroid storm. Symptoms of a thyroid storm can appear abruptly and seemingly without warning. However, now that you are more familiar with the contributing factors and indicators of a thyroid storm, you can better respond to thyroid events. If you experience symptoms of a thyroid storm seek immediate medical assistance.
Resources1. Carroll, Richard, and Glenn Matfin. “Endocrine and metabolic emergencies: thyroid storm.” Therapeutic advances in endocrinology and metabolism vol. 1,3 (2010): 139-45.
2. Karger S, Führer D. “Thyroid storm–thyrotoxic crisis: an update.” Dtsch Med Wochenschr. 2008 Mar;133(10):479-84.