Thyroid storm

Thyroid storm refers to an endocrine emergency caused by life threatening levels of thyroid hormones in the blood, which is often precipitated by surgery, stressful illness etc.

Thyroidits is associated with hypothyroidism, so surgery for thyroiditis does not precipitate thyroid storm.

Ref: Neurobiology of Epilepsy and Aging By R. Eugene Ramsay, Page 139; Harrison’s Internal Medicine, 17th Edition, Pages 2237, 2240

Ans. is ‘a’ Surgery for thyroiditis 

Thyroid storm or thyrotoxic crisis, is a rare event, presenting as a life threatening exacerbation of hyperthyroidism, accompanied by fever, delirium, seizures, coma, vomitting, diarrhoea and jaundice.

The mortality rate due to cardiac failure, arrythmia or hyperthermia is as high as 30% even with treatment. Causes of thyroid storm In an untreated or partially treated thyrotoxic patient following conditions causes thyroid storm:

– Acute illness (stroke, infection, trauma, diabetic ketoacidosis)

– Radioiodine treatment or

– Surgery (especially on thyroid)

Management of thyroid storm

• intensive monitoring & supporting care
• identification and t/t of precipitating cause
• Propylthiouracil

–  its inhibitory action on 14 —> T3 conversion makes it the antithyroid DOC.

• Stable iodine (potassium iodide, ipodate or iopanic acid)

– inhibits the hormone release from thyroid

– blocks thyroid hormone synthesis via the Wolff-Chaikoff effect

• Propranolol

– reduces tachycardia and other adrenergic manifestations

– also blocks T4 —> T3 conversion

• Glucocorticoids

Ans. is ‘b’ i.e., Radioactive iodine

• Thyroid storm is a life threatening exacerbation of thyrotoxicosis.
• Radioactive iodine is itself a precipitating cause of thyrotoxic crisis.
• Management is described in previous question.
• Lugol’s iodine is 5% iodine in 10% Potassium iodide solution.

Ans. is ‘a’ i.e., Inadequate control of hyperthyroidism 

Answer is A (Surgery for thyroiditis) :

Thyroid storm occurs in a thyrotoxic patient who has been inadequately prepared for thyroidectomy.

All options other than thyroiditis mentioned as options reflect a thyrotoxic state under stress and may lead to thyroid storm. Thyroiditis may not be necessarily associated with thyrotoxicosis. Infact many firms of thyroiditis have associated hypothyroidism and hence these patients are unlikely to develop thyroid storm when taken for surgery.

Thyroid storm is an extreme form of thyroitoxicosis that may occur with a variety of conditions:

Conditions that may lead to thyroid storm in thyrotoxic patients

Stressful illness Thyroid surgery

Radioactive iodine administration

Ans. C: Propylthiouracil

Propylthiouracil is used in thyroid storm for its inhibitory action on peripheral conversion of T4 to more active T3. It is also used in patients developing adverse effects with carbimazole.

Ans. is ‘b’ i.e., Reserpine