General Management

The mortality rate for thyroid storm is high. Reports vary but it is estimated to be 8-25% and much higher if unrecognised and untreated [15].

Consequently, the patient should be treated early and aggressively.

  • Initial Assessment: Start with airway and ventilatory status. Apply oxygen. Thyrotoxicosis itself is unlikely to cause an airway or breathing problem but underlying conditions such as pneumonia or sepsis may affect either.
  • Check haemodynamics; HR and BP.
  • ECG – assess is any arrhythmia is present
  • IV access – patients are likely markedly dehydrated – consider volume replacement with crystalloid [caution in elderly]
  • Send bloods including urea, electrolytes, full blood count, thyroid function tests and calcium. A venous gas can be helpful and a bedside glucose should be checked.
  • Urinary catheter
  • Cooling measures – antipyretics and standard cooling measures.
  • Chest X-Ray: may be useful in evaluating for an infective focus or provide evidence of cardiac failure.

Note: Aspirin should be avoided as it increases unbound thyroxine levels.