Everything you need to know about Thyroid Storm
Thyroid Storm or thyrotoxic crisis is a life-threatening situation which happens due to absence or poor treatment of ‘hyperthyroidism’. Although it’s a rare condition, it is highly critical and severe in nature. It can lead to rapid irregularities in heart rate, fever, nausea, heart failure and even death if not treated properly in time.
What is thyroid storm
Hyperthyroidism is a condition when there is an excess of thyroid hormones in the blood stream. This speeds up the metabolic process of the body. When Hyperthyroidism is not treated or receives substandard treatment, it leads to sudden worsening of the symptoms, leading to a Thyroid Storm.
Hyperthyroidism condition interferes with the metabolic process of the body. Thyroid storm is a condition that occurs when hyperthyroidism is extremely aggravated.. You need to be careful about hyperthyroidism and receive timely treatment in order to avoid such a fatal situation.
Functions of the Thyroid Gland
Before we discuss further about thyroid storm, let us try to understand a little about the thyroid gland and its disorders. The thyroid gland is situated under the Adam’s apple at the base of the neck. It produces thyroid hormones which are responsible for maintaining the metabolism of the body.
The thyroid gland produces Thyroxine (T4) and Triiodothyronine (T3) hormones. In other words, these hormones help in maintaining process that requires energy, e.g. regulation of the heart rate, nervous system, weight, muscle strength, Cholesterol levels etc.
Causes of Hyperthyroidism
Hyperthyroidism is caused due to an over-active thyroid gland. During this condition, the level of thyroid hormones in the blood stream is high. Let us look at why this may happen.
Hypothalamus is another important gland which is located in the brain. This gland releases a hormone called Thyrotropin Releasing Hormone (TRH) which stimulates the pituitary gland to release the Thyroid Stimulating Hormone (TSH). It is TSH that is responsible for stimulating the thyroid gland to secret the thyroid hormones.
Therefore, an over-production and over-secretion of thyroid hormones may happen when any of these three glands are over-active.
Thyroid Storm Causes
Thyroid Storm is a case of extreme hyperthyroidism which may occur when hyperthyroidism is not treated at all or not treated properly. Many other thyroid storm causes also exist. Some of the main thyroid storm causes are:-
- Lack of treatment or poor treatment of hyperthyroidism: Graves’ Disease, inflammation of the thyroid, over-consumption of iodine, excessive intake of thyroid hormones, toxic multi-nodular goiter, and over-secretion of TSH can all contribute to a Thyroid storm. In some cases, treatment of hyperthyroidism with radioactive iodine therapy can also lead to a thyroid storm.
- Lack of treatment and an over-functioning thyroid gland: An overactive gland is dangerous and fatal for the body.
- Experiences of trauma, surgery, stress etc: A major stressful event such as an accident, trauma, surgery, stroke or an emotional disorder
- Other infections as a result of hyperthyroidism
Thyroid Storm Symptoms
Thyroid storm symptoms are similar to those of hyperthyroidism. However, thyroid storm symptoms are much more aggravated, severe, and sudden in nature. A patient showing thyroid storm symptoms needs immediate care.
Most Common Thyroid Storm Symptoms
Some most common Thyroid Storm symptoms are
- Extreme hyperthyroid symptoms
- Abnormal and irregular heart rate
- Restlessness and over sweating
- Irregular blood pressure
- Heart attack
- Increased temperature/fever
In this particular condition, your systolic blood pressure is higher and the diastolic blood pressure is lower than normal (140/90 mm hg). You will also have a considerably high heart rate. You should never delay the right treatment if there is a slightest display of any of the Thyroid Storm symptoms.
Thyroid Storm Management
Thyroid storm is a condition in which hyperthyroidism is extremely elevated. The metabolic processes of the body run at a very rapid rate because of over-secretion of the thyroid hormones T3 and T4. This may send vital organs of the body into an over-hauled condition, causing extreme discomfort and even death.
Therefore, thyroid storm management requires dealing aggressively and quickly with the various thyroid storm symptoms. Tt is extremely important to seek aggressive and expert help immediately. For thyroid storm management, the patient needs to be taken to the ICU (intensive care unit) at the earliest.
For prominent management, following immediate treatment may be given to deal with the highly elevated thyroid storm symptoms:-
Palliative Care for Thyroid Storm Management
- Body Temperature: Doctors give antipyretics to the patient to control the fever of the body. They also provide acetaminophen to the patient in cases of thyroid storm management. Other cooling techniques like head cooling etc may also be given.
- Irritation: For extreme agitation experienced by patients, benzodiazepines may be given to control the symptoms.
- Blood pressure and heart rate: In thyroid storm management, to deal with the instability of the blood vessels, Intravenous fluids (IV fluids) are administered.
Peripheral Effects Management
It is also important to block the peripheral effects that occur due to excess of thyroid hormone in the blood stream during thyroid storm management. Therefore, certain drugs known as beta-blockers (β-blockers) are given to the patient. Beta blockers also help in reducing the effect of the thyroid hormones present in the bloodstream on the organs of the body, thus supporting in management of this dangerous condition.
The beta blockers like propranolol and metoprolol will help in reducing the conversion of T4 hormone into T3. This can be really critical in Thyroid storm management. Apart from that, beta blockers may also help in relieving from high fever, tremors, and irritation.
Beta blockers may have side effects on heart patients and therefore need aggressive care in their use and dosage in storm’s management.
The use of iodine in thyroid management for storm is done to stop further release of the thyroid hormones that are already stored in the thyroid gland.
Thyrotoxicosis vs thyroid storm
While thyroid storm is a severe manifestation and consequence of hyperthyroidism, Thyrotoxicosis in most cases is a cause of hyperthyroidism. Hence, extreme Thyrotoxicosis is one of the causes of thyroid storm. Hyperthyroidism is a state when there is an over active thyroid gland which causes surplus secretion of the thyroid hormone.
Causes of Thyrotoxicosis
Thyrotoxicosis is a medical condition where there is excess and uncontrolled transmission and circulation of thyroid hormones in the blood stream. Hyperthyroidism is a common cause of Thyrotoxicosis.
The excess secretion of thyroid hormones is not always because of an over active thyroid gland. In fact, Thyrotoxicosis can result from rupture of thyroid follicles, inflammation of the thyroid gland or because of excessive intake of thyroid hormones.
The relation between Thyrotoxicosis and Thyroid Storm
Generally, Thyrotoxicosis and Hyperthyroidism are used as synonyms, but though a person suffering from hyperthyroidism is inductively also suffering from Thyrotoxicosis, a thyrotocix person need not necessarily have an over active thyroid gland.
Thyroid storm on the other hand is a condition where there is a sudden and immediate release of excessive thyroid hormones in the blood stream. It is a complicated and severe form of Hyperthyroidism. Thyroid storm can be caused by a poor or no treatment for hyperthyroidism or Thyrotoxicosis.
Thyrotoxicosis and Thyroid Storm Causes and Treatment
Any stressful events or experiences like accident, surgery, extensive emotional distress can act as a trigger for people suffering from Thyrotoxicosis and lead to sudden production of excessive hormones and result in Thyroid Storm.
While Thyrotoxicosis and Thyroid storm both have medications for treatments options, the latter requires a more immediate and critical care. In cases of later one, you have to go to the emergency section or intensive care unit immediately; even before your blood test results for storm are confirmed.
Feline Thyroid Storm
Veterinary science and medicine does not completely recognize Feline Thyroid Storm as a disease. The nature of this condition has not been well discovered or documented for cats even though cats suffering from hyperthyroidism display signs and symptoms similar to that of humans suffering from a this severe condition. A better study of these syndromes in cats is required at this point.
Thyroid Storm Pathophysiology
The pathophysiology of this disease has still not been well defined and rather appears to be more intuitive.
Some organs of the body go into the state of decompensation during a storm of thyroid. Decompensation means that due to sudden fluctuation in metabolic processes because of a disease, some organs like the liver, heart or the kidney are not able to compensate even with their elevated performance rates.
Thyroid storm pathophysiology is attributed to severe manifestations of thyroid hormones, but studies reflect that the conditions are no different than some forms of uncomplicated thyrotoxicosis.
There are no clear markings or differences to underline this condition of thyroid. The presence of higher amount of T3 and T4 is considered to be the underlying cause. However, there have been few instances where a patient suffered from Thyroid Storm even though their levels of T3 and T4 were not excessively high.
Thyroid Storm Treatment
This thyroid problem is the last extreme condition in the entire gamut of thyroid disorders and has high mortality rates. It compromises vital organs and has a damaging effect on the body. Therefore, it is essential to get immediate and aggressive Thyroid Storm treatment.
If you are experiencing possible Thyroid Storm symptoms or know someone who is, you should consult a doctor immediately.
The treatment starts with blood tests to measure the level thyroid hormones in the blood stream. Thyroid Storm treatment is begun even before waiting for the results of the blood test in many a cases.
Primary aims of Thyroid Storm Treatment
- Reduce thyroid hormone levels in the blood stream
- Avoid release of extra or excess thyroid hormones
- Manage and regulate effects of hormones on the heart rate
- Thyroid Storm treatment for treating the consequences of like agitation, fever, vascular instability etc.
Processes of Thyroid Storm Treatment
Medications and other measures to reduce thyroid hormones levels
Reducing the level of thyroid hormones in blood is extremely important in Thyroid storm treatment. Doctors follow the five main B’s of thyroid storm treatment, as discussed below:
- Block synthesis of thyroid hormones
Medications like anti-thyroid drugs are generally prescribed to treat an overactive thyroid gland and reduce the hormone levels. While T4 gets reduced, T3 and TSH hormone levels take far greater amount of time.
Some examples of anti-thyroids for Thyroid Storm treatment are propylthiouracil or methimazole. Methimazole is preferred as it works faster and has fewer adverse effects. Methimazole is administered especially in cases dealing with pregnant women.
- Block release of excess thyroid hormones
Radioactive iodine is generally used to control the emission of already stored thyroid hormones from the thyroid gland.
- Blocking conversion of T4 into T3
T4 is an inactive hormone as compared to T3. While T3 is produced in lesser amounts, T4 can get converted to T3. Propranolol and corticosteroids are the commonly used medications in thyroid storm treatment to prevent this conversion.
- Beta Blocker
Beta blockers are used to deal with the adverse effects of hormones on the nervous system in thyroid storm treatment.
- Block circulation of biliary acids,
The production of biliary acids and bilirubin or other substances is stopped by the use of cholestyraminein thyroid storm treatment.
Thyroid Storm treatment by treating hyperthyroidism
In some cases, the treatment includes treating hyperthyroidism by radioactive iodine. Radioactive iodine is never used for Thyroid Storm treatment in pregnant women, because it affects the child during pregnancy. Some people are also allergic to radioactive iodine.
Thyroid surgery is sometimes used to treat hyperthyroidism in the longer run . The thyroid gland is removed completely or partially for an effective treatment of thyroid storm.
Treatment with oxygen, fluids, medicines etc.
In a few cases where the patient has problems in inhaling or there is a great loss of water, thyroid storm treatment can include use of oxygen, fluids, vitamins and other medicines. Constant checkups are done to regulate any excess fluids in patients. Patients are given medicines or other antibiotics depending on the degree of infection.
The storming of thyroid is a critical life-threatening situation. You need to consult a doctor and take effective Thyroid Storm Treatment as soon as possible.
Thyroid Storm Anesthesia
This is seriously a risky condition, and so are the available thyroid storm treatment options. Thyriodeictemy or removal of partial or complete thyroid gland itself is one of the most common thyroid storm treatment procedures followed.
The effects of Thyroid storm are really harmful and impact the body critically. Therefore, performing a surgery becomes much more critical.
Administration of anesthesia to such patients is a very challenging job. It can arise complications during, before or after the surgery.