[Thyroid storm--thyrotoxic crisis: an update].
Thyroid storm or thyrotoxic crisis is a rare but life-threatening condition requiring immediate treatment, preferably in an intensive care unit. Its incidence is about 1-2% among patients with overt hyperthyroidism. A thyrotoxic crisis occurs predominantly in the elderly and is three to five times more common in women than in men. The overall mortality is 10-20%. Even though the pathogenesis is still not fully understood, an increased sensitivity to catecholamines appears to be an important mechanism, and a number of endogenous and exogenous stress factors that can provoke the onset of a thyrotoxic storm have been identified. The diagnosis of a thyrotoxic crisis is made entirely on the clinical findings. Most importantly, there is no difference in thyroid hormone levels between patients with "uncomplicated" thyrotoxicosis and those undergoing a thyroid storm. Any delay in therapy, e.g. by awaiting additional laboratory results, must be strictly avoided, because the mortality rate may rise to 75%. Thus early thyroidectomy should be considered as the treatment of choice, if medical treatment fails to result in clinical improvement. Medical treatment is based on three principles: 1) counteracting the peripheral effects of thyroid hormones; 2) inhibition of thyroid hormone synthesis; and 3) treatment of systemic complications. These measures should bring about clinical improvement within 12-24 hours. If death occurs it is most likely to be cardiopulmonary failure, particularly in the elderly.
Karger
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S
Klinik für Endokrinologie, Diabetologie und Nephrologie, Universitätsklinikum Leipzig, Leipzig, Germany.
Führer
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D
0000-0003-0357-4192
D018674:Adrenergic Antagonists / Q000627:therapeutic use; D013956:Antithyroid Agents / Q000627:therapeutic use; D002395:Catecholamines / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications; D007455:Iodine / Q000009:adverse effects; D008297:Male; D013312:Stress, Physiological / Q000150:complications; D013958:Thyroid Crisis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
D018674:Adrenergic Antagonists; D013956:Antithyroid Agents; D002395:Catecholamines; D007455:Iodine