THYROID STORM IN THE EMERGENCY DEPARTMENT: EARLY DIAGNOSIS AND TREATMENT
Keywords:
thyroid storm; thyrotoxicosis; emergency medicine; critical care; antithyroid drugs; plasma exchangeAbstract
DOI: https://doi.org/10.46296/yc.v10i19.0976
Abstract
Background: Thyroid storm is a rare, life-threatening endocrine emergency whose multisystem presentation may mimic sepsis, cardiogenic shock, acute coronary syndrome, or an acute abdomen. Early recognition and parallel initiation of supportive care and therapies that block thyroid hormone synthesis, release, and peripheral effects are central to outcome. Objective: To synthesize clinical evidence on early diagnosis, severity predictors, and treatment strategies for thyroid storm in emergency and critical-care settings. Methods: PRISMA 2020–aligned systematic review. PubMed/MEDLINE was searched from January 2000 through April 30, 2026. Primary studies reporting diagnostic, therapeutic, or prognostic outcomes in thyroid storm were prioritized. Seventy-one records were identified, 29 reports were assessed for eligibility, and 20 studies were included in qualitative synthesis. Meta-analysis was not performed because of substantial clinical and methodological heterogeneity. Results: Mortality was highest among critically ill patients with cardiogenic shock, neurologic dysfunction, multiorgan failure, or disseminated intravascular coagulation. Burch-Wartofsky and Japanese criteria are complementary clinical tools, but treatment should not be delayed when clinical suspicion is high. Contemporary observational comparisons did not demonstrate a consistent outcome advantage of propylthiouracil over methimazole. Beta-blocker selection requires caution in decompensated heart failure. Potassium iodide, glucocorticoids, and trigger control remain components of multimodal treatment, while therapeutic plasma exchange, mechanical circulatory support, and urgent thyroidectomy may be considered as rescue strategies in selected refractory cases. Conclusions: Thyroid storm should be approached as a time-critical clinical diagnosis. Early hemodynamic stabilization, cautious adrenergic control, antithyroid therapy, and trigger management should proceed in parallel. Comparative evidence remains mainly observational.
Keywords: thyroid storm; thyrotoxicosis; emergency medicine; critical care; antithyroid drugs; plasma exchange.
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