Endocrine Abstracts

Background: Thyroid storm (TS) is a rare, acute, severe, and potentially fatal complication of untreated or poorly managed hyperthyroidism. In such cases, there is multisystem involvement and an 8-25% risk of mortality; hence, early identification and prompt initiation of vigorous treatment is crucial to reduce mortality. Beta adrenergic receptors blockers (BBs) are commonly used early in the treatment of TS, however the risk of inducing circulatory failure (BBIS) remains a major concern. We aim to explore the BBIS in a large scale-data from different populations worldwide.

Methods: Data were collected between January 2003 and December 2023 from published cases on PUBMED/MEDLINE. We included all age groups, genders who had been diagnosed with TS based on clinical, laboratory and Burch-Wartofsky Point Scale (BWPS) and received BBs early in the treatment of TS. Patients were subdivided into non-BBIS and BBIS, and data were analyzed and compared using Chi-Square and student t test. Multivariable logistic regression analysis was performed to identify the predictors of mortality.

Results: We analyzed 367 TS cases who fulfilled the eligible criteria (65% female and 35% male) with a mean age of 40±17 and BWPS 62±18. The overall mortality was 11.4% and BBIS occurred in 70 patients (19%). Age, gender, BWPS, BNP and troponin were comparable between the study groups. Patients who developed BBIS had significantly higher rate of atrial fibrillation, heart failure, lower left ventricular ejection fraction, multiorgan failure, cardiac arrest and mortality compared with those without BBIS. The BBIS group received more CCB, amiodarone, TPE, CRRT, and ECMO. Multivariable analysis showed that only BBIS (Odds ratio 3.0) and CRRT (Odds ratio 8.0) were the predictors of mortality after adjusting for age, gender, low ejection fraction, and renal failure and liver failure and the use of CCB, ECMO, and TPE. The mortality is 5 times higher in the BBIS group compared to non-BBIS.

Conclusion: BBIS in the treatment of TS occurs almost in one out of five TS patients treated with BBs. In addition to CRRT, BBIS independently predicts the mortality in TS patients.