Endocrine Abstracts

Thyroid storm (TS) is a rare but life-threatening manifestation of thyrotoxicosis.

Objective: To describe the clinical features and outcomes of patients admitted for TS according to Burch-Wartofsky’s score (BW).

Methods: A retrospective review of subjects admitted to a single hospital from 2009 through 2015 was conducted.

Results: 15 cases were identified. Etiology: autoimmune (n=8), factitious (n=3), amiodarone-induced (n=3), undetermined (n=1). Manifestations at admission were: cardiovascular (n=8), fever (n=3), delirium (n=2), diabetic ketoacidosis (n=1) and hypokalemic paralysis (n=1). Eleven had previous history of thyroid disease (7 hyperthyroidism, 4 hypothyroidism). Hipokalemia (hk) was found in 8 cases and precipitating factors in 12. Thyroid hormone levels did not correlate with the severity of thyrotoxicosis according to BW. One patient died from sepsis. Late hospital discharge was found in 4 patients (P=0.01): 3 required antithyroid drugs withdrawal (febrile neutropenia, cholestasis, digestive intolerance) and the other received a heart transplant.

Conclusions: We found 4 cases of TS per 10000 admitted. The most common etiology was autoimmune. Cardiovascular manifestations were predominant. Precipitating factors were identified in 80% of patients. Unusual findings were high consumption of iodine, hk, factitious thyrotoxicosis and a prior history of hypothyroidism. Mortality rate was 6.6%. Treatment with antithyroid drugs was associated with a significant shorter time of hospitalization. This review adds data to the few previous reports and provides useful information for the management of TS, a rare and acute disease that requires high clinical suspicion in order to improve patient survival.