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Case Details

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Thyroid storm

  • Author: Dr. Hasan Altarrah
  • Published Date: 13/05/2026
  • Last Modified Date:
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  • Reviews: ( 0 Reviews )
  • Category :Internal Medicine
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Additional Information:

  • Thyroid: storm

Description

Clinical Presentation
  • SOB
  • Palpitations
  • Diarrhea
  • Weight loss
  • Orthopnea
Diagnosis
  • Clinical diagnosis
  • Supportive score: Burch-Wartofsky point scale
  • Other presentations: atrial fibrillation and ischemic stroke
O/E
  • Heart rate 140
  • Blood pressure 140/90
  • Chest crackles
  • LE edema
Labs & Other Tests
  • TSH: 0.001
  • FT4: 56
  • Anti-TSH antibody
Causes of Hyperthyroidism
  • Graves’ disease
  • Multinodular goiter (MNG)
  • Toxic thyroid adenoma
  • Subacute thyroiditis
  • Drugs like amiodarone or excess levothyroxine
  • Postpartum thyroiditis
  • Struma ovarii
  • Hypersecretion of TSH by pituitary adenoma
Remember
  • Rule out infectious and precipitating causes
Management
  • ABC management
  • Beta blocker: Propranolol 60–80 mg orally every 4–6 hours
  • Potassium iodide or Lugol’s iodine
  • Anti-thyroid medications
  • Steroid: Hydrocortisone IV 300 mg loading dose, then 100 mg every 8 hours
  • Cholestyramine 4 g orally four times daily may help in severe cases, especially if allergic to thionamides
  • Surgery
Follow Up
  • Check FT4 and T3
  • Taper and discontinue steroid
  • Cardiac monitoring
  • Stop beta blocker if TFT becomes normal
  • Consider radioiodine or surgery for Graves’ disease

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