Thyroid Storm

What is Thyroid Storm?

Thyroid storm is a serious health condition that occurs due to an overactive thyroid gland or untreated thyrotoxicosis. This condition can cause your blood pressure and body temperatures to reach harmful levels and without quick medical attention, it may become fatal^{1, 4}.

Thyroid storm affects people with thyrotoxicosis but it is more common in females. But there are no specific data to prove this sex incidence. Thyroid storm occurs in those people who are in adolescent stage but it can happen to people at all ages⁶.

A thyroid gland is a gland that is shaped like a butterfly and is found at the base of your neck. It is part of the endocrine system which has organs responsible for producing hormones in the body for particular functions. It secrets hormones that regulate body metabolism; that is how the body utilizes energy. The following are functions controlled by thyroid hormones: breathing, body temperature, body weight, cholesterol level, menstrual cycle, heart rate, etc^{3, 4}.

Pituitary & Thyroid Gland (Hormone Cycle)

Causes

Thyroid storm can be caused by a number of factors such as:

Untreated overactive thyroid gland

This is also known as Hyperthyroidism, it is a condition where there is excess production of thyroid hormones. When this occurs, most of the body functions speeds up rapidly. There are several causes of overactive thyroid gland. They include:

Graves disease

This is an autoimmune condition in which the antibodies trigger thyroid gland to secrete too much thyroid hormones. Researchers have not yet identified the cause of Grave’s disease but it is passed from one member of the family to another. This disease affects mostly women. Some people with this disease can develop other conditions such as Graves’ ophthalmopathy which can cause your eyes to bulge, blurred vision or increase your sensitivity to light. In uncommon cases, this disease can cause a condition which may lead to swelling and redness of your skin.

Toxic nodular or multinodular goiters- lump

These are bumps or swellings in the thyroid gland that stimulate it to release excess amounts of thyroid hormones.

Thyroiditis

This is a condition that causes thyroid gland to become inflamed. It is as a result of a viral infection or another disorder and it causes short-lived hyperthyroidism.

Excess Iodine

People who eat a lot of Iodine in their diets or take drugs that have Iodine are more likely to develop hyperthyroidism.

When hyperthyroidism is left unattended to medically, it may cause thyroid storm which is life-threatening and can become fatal.

People with an overactive thyroid gland may develop thyroid storms when they experience any of the following:

• Stroke
• Pulmonary embolism
• Congestive heart failure
• Painful depression
• Injury on the neck
• Diabetic ketoacidosis
• Surgery on the neck^2,3

Symptoms & Signs

Symptoms of thyroid storm are much the same as those of hyperthyroidism but they are more abrupt and painful. These symptoms are unbearable and people need assistance to help them look for medical care. The following are some of the symptoms of thyroid storm:

People with thyroid gland experience high body temperatures (fever). They also sweat persistently. They have a higher than normal heart rate usually more than 140 beats in 6o seconds. Some people appear confused and restless. You may also have diarrhea. Some people are easily agitated and are unconscious, while others shake.¹

Diagnosis

Thyroid storm can be diagnosed though the following:

Diagnostic Criteria for Thyroid Storm

Physical exam

Your doctor would try to find out your past health record and assess any changes in your eyes and skin. Your doctor also examines your thyroid gland as you swallow to find out if it’s enlarged or there is a lump there. Your doctor also examines your heart rate to see if it’s fast.

Blood test

Your doctor conducts blood tests to measure the amount of thyroxin and TSH in your blood. When the levels of thyroxin hormones are high and TSH levels are low, it means that you have an overactive thyroid gland. If tests indicate that you have overactive thyroid, the following test would be conducted:

Radio Iodine test

In this test, your doctor gives you an oral dose of radioiodine to take. Your doctor will check on you after two, six or twenty four hours to find out the amount of Iodine that have been absorbed. If high amounts of radioiodine have been absorbed, it indicates that your thyroid gland is secreting excess thyroxin. This test (radio iodine) can expose you to some radiation which can be harmful to your health.^5,6

Treatment

There are many treatment options for overactive thyroid which depend on the patient’s age, underlying cause and physical condition. The following treatment could be used:

Radioactive Iodine

Your doctor recommends radioactive Iodine which you take orally. Radioactive Iodine is absorbed by the thyroid gland and it causes the gland to decrease in size and relieve the symptoms within six months. You have to use radioactive Iodine every day for two months so as to reduce the level of thyroxin.

Anti-thyroid medications

These drugs prevent thyroid gland from manufacturing too much amounts of hormones. Your doctor recommends the following: methimazole and propylthiouracil. After six to 12 weeks, the symptoms begin to improve but you have to continue tasking these medications for a year or longer for effective results. People would experience different results when using these medications; in some people the symptoms disappear completely while others experience relapses. These drugs can damage the liver and cause death. Propylthiouracil accounts for severe damage to the liver and it is recommended that it should not be used unless the patient is not able to tolerate methimazole. These drugs also cause skin rashes, fever and pain the joints in some patients.

Beta blockers

These drugs are used to decrease a rapid heart rate. Your doctor recommends them to help you feel better until thyroid levels become normal.

Thyroidectomy

This type of surgery is only recommended for expectant women and those people who cannot tolerate anti-thyroid drugs and those who are reluctant to undergo radioactive iodine therapy. In thyroidectomy, your doctor extracts most of your thyroid gland. This procedure may damage your parathyroid glands (these are four glands located at the back of your thyroid gland which regulate the level of calcium in the blood) and vocal cord.

Thyroid storm is a serious condition that can cause death, therefore seek for urgent medical attention immediately you notice the symptoms mentioned above.⁶

Reference List

1. http://www.healthline.com/health/thyroid-storm#treatment5
2. Thyroid storm. http://emedicine.medscape.com/article/925147-overview#a6
3. http://www.webmd.com/women/tc/thyroid-storm-topic-overview
4. Thyroid gland. https://medlineplus.gov/ency/article/000400.htm
5. Thyroid storm. http://pedemmorsels.com/thyroid-storm/
6. Overactive thyroid. http://www.mayoclinic.org/diseases-conditions/hyperthyroidism/basics/definition/con-20020986