Thyrotoxic Storm Following Thyroidectomy
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Thyroid storm is a clinical manifestation of an extreme hyperthyroid state that results in significant morbidity or disability or even death. Previously, thyroid storm was a common complication of toxic goiter surgery during intraoperative and postoperative stages. Preoperative control of the thyrotoxic state and use of radioiodine ablation has greatly reduced this phenomenon. Today, thyroid storm more commonly is seen in a thyrotoxic patient with intercurrent illness or surgical emergency. Early recognition and prompt intervention are necessary to prevail in management of this phenomenon.
International
Presently, incidence is less than 10% among patients hospitalized for thyrotoxicosis.
Thyroid storm, considered a fulminating state, is fatal when untreated.
Although methods of diagnosis and management have improved considerably, reported mortality still is 20-30%.
Although it can develop in toxic adenoma or multinodular toxic goiter, thyroid storm is more commonly seen in toxicity secondary to Graves disease. See the image below.
Age and sex predilection depends on the etiology of thyrotoxicity. Graves disease more frequently develops in females (ie, male-to-female ratio ranges from 1:7 to 1:10); multinodular goiter more often manifests in the elderly population.
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Uncomplicated Thyrotoxicosis
Thyroid Storm
1. Heat intolerance, diaphoresis
1. Hyperpyrexia, temperature in excess of 106o C, dehydration
2. Sinus tachycardia, heart rate 100-140
2. Heart rate faster than 140 beats/min, hypotension, atrial dysrhythmias, congestive heart failure
3. Diarrhea, increased appetite with loss of weight
3. Nausea, vomiting, severe diarrhea, abdominal pain, hepatocellular dysfunction-jaundice
4. Anxiety, restlessness
4. Confusion, agitation, delirium, frank psychosis, seizures, stupor or coma
Peter F Czako, MD, FACS Chief, Division of Endocrine Surgery, Medical Director, North Tower Operating Rooms, Surgical Administration, William Beaumont Hospital; Associate Professor, Department of Surgery, Oakland University William Beaumont School of Medicine; Royal Oak Surgical Associates, PC
Peter F Czako, MD, FACS is a member of the following medical societies: American College of Surgeons, American Medical Association, Michigan State Medical Society, American Association of Endocrine Surgeons, Detroit Surgical Society
Disclosure: Nothing to disclose.
Nafisa K Kuwajerwala, MD Staff Surgeon, Breast Care Center, William Beaumont Hospital
Nafisa K Kuwajerwala, MD is a member of the following medical societies: American College of Surgeons, American Society of Breast Surgeons, American Society of Breast Disease
Disclosure: Nothing to disclose.
Gunateet Goswami, MD Consulting Staff, Internal Medicine Associates, Mount Clemens, Michigan; Consulting Staff, Department of Cardiology, Henry Ford Hospital
Gunateet Goswami, MD is a member of the following medical societies: American Medical Association, American Society of Echocardiography, Michigan State Medical Society
Disclosure: Nothing to disclose.
Thabet Abbarah, MD, FACS Consulting Staff, Department of Otolaryngology, North Oakland Medical Centers
Thabet Abbarah, MD, FACS is a member of the following medical societies: American College of Surgeons
Disclosure: Nothing to disclose.
Venkata Subramanian Kanthimathinathan, MD Fellow in Bariatric/Advanced Laparoscopic Surgery, University of Missouri Healthcare
Disclosure: Nothing to disclose.
Pankaj Chaturvedi, MBBS, MS, FACS Professor of Head and Neck Surgery, Department of Head and Neck Surgery, Tata Memorial Hospital, India
Pankaj Chaturvedi, MBBS, MS, FACS is a member of the following medical societies: American Association for the Advancement of Science, American Head and Neck Society, Association of Surgeons of India
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Received salary from Medscape for employment. for: Medscape.
Dean Toriumi, MD Associate Professor, Department of Otolaryngology, University of Illinois Medical Center
Disclosure: Nothing to disclose.
Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society
Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;Preacute Population Health Management;The Physicians Edge<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; for: Rxblockchain;Bridge Health.
Mimi S Kokoska, MD Physician, Department of Otolaryngology-Head and Neck Surgery, Aurora Health Care
Mimi S Kokoska, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Association for Physician Leadership, American College of Surgeons, American Head and Neck Society
Disclosure: Nothing to disclose.
Thyrotoxic Storm Following Thyroidectomy
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