Thyroid storm
Formal Definition
A life-threatening exacerbation of hyperthyroidism with extreme elevation of thyroid hormone activity causing severe systemic manifestations including hyperpyrexia, tachyarrhythmia, altered mental status, and cardiovascular compromise; a clinical diagnosis scored by the Burch-Wartofsky Point Scale in the absence of reliable confirmatory labs.
How It's Used on the Ward
"Storm" — the rare, severe presentation of uncontrolled hyperthyroidism that requires ICU-level care and aggressive multi-drug blockade.
Example
""Post-thyroidectomy day 1 patient with HR 148, temperature 40.1, confusion, and vomiting: Burch-Wartofsky score of 65 — thyroid storm. Starting PTU, SSKI, propranolol, hydrocortisone, and cooling measures simultaneously.""
Clinical Context
Treatment requires multi-drug blockade in sequence: 1) PTU (propylthiouracil) or methimazole to block new thyroid hormone synthesis. 2) Iodine (SSKI or Lugol) given 1 hour AFTER PTU to block hormone release (giving iodine first paradoxically increases production). 3) Beta-blocker (propranolol) to blunt sympathomimetic effects. 4) Corticosteroids (block peripheral T4→T3 conversion). 5) Supportive: cooling, fluids, treat precipitant. Precipitants: infection, surgery, trauma, iodinated contrast, medication non-adherence. Mortality 10–25% even with treatment.
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