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Cited by 852Thyroid Disorders and TreatmentsOphthalmology and Eye DisordersAdrenal Hormones and Disorders

Life-Threatening Thyrotoxicosis: Thyroid Storm

Burch, Henry B., Wartofsky, Leonard·1993·Endocrinology and Metabolism Clinics of North America
DOI 10.1016/s0889-8529(18)30165-8
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Abstract

Although important strides in recognition and therapy have significantly reduced the mortality in this disorder from the nearly 100% fatality rate noted by Lahey, survival is by no means guaranteed. More recent series have yielded fatality rates between 20% and 50%. Although some authors have attributed this improvement, in part, to a relaxation of the diagnostic criteria for thyroid storm, it more likely represents improvements in early recognition and the beneficial effects of the serial addition of antithyroid, corticosteroid, and antiadrenergic therapies to the treatment of this disorder. Thyroid storm is a dreaded, fortunately rare complication of a very common disorder. Most cases of thyroid storm occur following a precipitating event or intercurrent illness. Effective management is predicated on a prompt recognition of impending thyroid storm which is, in turn, dependent on a thorough knowledge of both the typical and atypical presentations of this disorder. An unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.

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Crossref · 10.1016/s0889-8529(18)30165-8

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83 of 83 references verified0 citation errors · 0 not checkable

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  • Untreated or partially treated thyrotoxicosis is associated with weight loss, osteoporosis, atrial fibrillation, embolic events, muscle weakness, tremor, neuropsychiatric symptoms, and rarely cardiovascular collapse and death.

    “Untreated or partially treated thyrotoxicosis is associated with weight loss, osteoporosis, atrial fibrillation, embolic events, muscle weakness, tremor, neuropsychiatric symptoms, and rarely cardiovascular collapse and death (26,27).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [26]

  • In the BWPS system, a point total of ≥45 is consistent with thyroid storm, 25-44 points is classified as impending thyroid storm, and <25 points makes thyroid storm unlikely.

    “Points in the BWPS system are based on the severity of individual manifestations, with a point total of ‡45 consistent with thyroid storm, 25-44 points classified as impending thyroid storm, and <25 points making thyroid storm unlikely.”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [26]

  • The treatment strategy for thyroid storm can be broadly divided into therapy directed against thyroid hormone secretion and synthesis, measures directed against the peripheral action of thyroid hormone, reversal of systemic decompensation, treatment of the precipitating event or intercurrent illness, and definitive therapy.

    “The treatment strategy for thyroid storm can be broadly divided into (i) therapy directed against thyroid hormone secretion and synthesis; (ii) measures directed against the peripheral action of thyroid hormone at the tissue level; (iii) reversal of systemic decompensation; (iv) treatment of the precipitating event or intercurrent illness; and (v) definitive therapy (26).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [26]

  • Diagnostic criteria for thyroid storm in patients with severe thyrotoxicosis were first proposed in 1993 and subsequently widely adopted as the Burch-Wartofsky Point Scale (BWPS) for thyroid storm.

    “Diagnostic criteria for thyroid storm in patients with severe thyrotoxicosis were first proposed in 1993 and subsequently widely adopted as the BWPS for thyroid storm (26,72,186,226,228).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [26]

  • The BWPS criteria include hyperpyrexia, tachycardia, arrhythmias, congestive heart failure, agitation, delirium, psychosis, stupor, coma, nausea, vomiting, diarrhea, hepatic failure, and the presence of an identified precipitant.

    “These criteria (Table 6) include hyperpyrexia, tachycardia, arrhythmias, congestive heart failure, agitation, delirium, psychosis, stupor, and coma, as well as nausea, vomiting, diarrhea, hepatic failure, and the presence of an identified precipitant (26).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [26]

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Authors
Burch, H. B., & Wartofsky, L.
Affiliations
Uniformed Services University of the Health Sciences (US)
Corresponding author
Wartofsky, Leonard
ORCID
Venue
Endocrinology and Metabolism Clinics of North America
Publisher
Elsevier BV
Published
1993-06
Volume
22
Issue
2
Pages
263-277
ISSN
0889-8529 (ISSN-L)
DOI
10.1016/s0889-8529(18)30165-8
OpenAlex
W2258987210
Cited by
852
References
83
Citations by year
2026: 45 · 2025: 54 · 2024: 50 · 2023: 51 · 2022: 59 · 2021: 48 · 2020: 58 · 2019: 36 · 2018: 41 · 2017: 34 · 2016: 35 · 2015: 36 · 2014: 50 · 2013: 29 · 2012: 27
FWCI
2.41
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Endocrinology and Metabolism Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Ophthalmology and Eye Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords
thyroid storm, thyrotoxicosis, hyperthyroidism complications, mortality, early recognition, antithyroid drugs, corticosteroids, atypical presentation
MeSH terms
Humans, Thyroid Crisis

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